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General NPI Number Information
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NPI Number | 1487713863
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Entity Type | Organization
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Legal Business Name | PLAZA PROFESSIONAL PHARMACY INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 10/31/2013
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Provider Practice Location Address
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Address Line | 1717 BELLEVUE AVE
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City | RICHMOND
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State | VA
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Zip | 23227-3961
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Country | US
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Telephone | 804-264-1319
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Fax | 804-264-2133
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Provider Business Mailing Address
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Address Line | 1717 BELLEVUE AVE
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City | RICHMOND
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State | VA
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Zip | 23227-3961
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Country | US
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Telephone | 804-264-1319
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Fax | 804-264-2133
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. EDWARD M SHIBLEY JR.
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Credential | RPH, MBA
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Telephone | 804-264-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0201001356
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License Number State | VA
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