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General NPI Number Information
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NPI Number | 1366446833
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Entity Type | Organization
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Legal Business Name | PARK PLAZA PHARMACY, INC.
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Dates
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Enumeration Date | 06/12/2005
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 343 HIGHWAY 34
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City | MATAWAN
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State | NJ
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Zip | 07747-9514
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Country | US
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Telephone | 732-290-9111
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Fax | 732-441-3693
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Provider Business Mailing Address
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Address Line | 343 HIGHWAY 34
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City | MATAWAN
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State | NJ
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Zip | 07747-9514
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Country | US
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Telephone | 732-290-9111
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Fax | 732-441-3693
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Authorized Official
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Title or Position | OWNER
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Name | MR. VADYM DETS
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Credential |
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Telephone | 732-290-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00383600
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License Number State | NJ
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