Healthcare Provider Details

I. General information

NPI: 1649308933
Provider Name (Legal Business Name): PLAZA WEST PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 W 10TH ST
SEDALIA MO
65301-2111
US

IV. Provider business mailing address

3330 W 10TH ST
SEDALIA MO
65301-2111
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-0000
  • Fax: 660-826-3525
Mailing address:
  • Phone: 660-827-0000
  • Fax: 660-826-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number005611
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN D KNORP
Title or Position: OWNER
Credential: RPH.
Phone: 660-221-2735