Healthcare Provider Details

I. General information

NPI: 1982689956
Provider Name (Legal Business Name): PLAZA DRUG CO. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E MAIN ST
WEST POINT MS
39773-3005
US

IV. Provider business mailing address

545 E MAIN ST
WEST POINT MS
39773-3005
US

V. Phone/Fax

Practice location:
  • Phone: 662-494-2535
  • Fax: 662-494-2200
Mailing address:
  • Phone: 662-494-2535
  • Fax: 662-494-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0062101.1
License Number StateMS

VIII. Authorized Official

Name: MR. JOHN COLON JOHNSON
Title or Position: PRESIDENT
Credential: R. PH.
Phone: 662-494-2535