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General NPI Number Information
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NPI Number | 1649308933
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Entity Type | Organization
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Legal Business Name | PLAZA WEST PHARMACY, INC
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 3330 W 10TH ST
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City | SEDALIA
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State | MO
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Zip | 65301-2111
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Country | US
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Telephone | 660-827-0000
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Fax | 660-826-3525
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Provider Business Mailing Address
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Address Line | 3330 W 10TH ST
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City | SEDALIA
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State | MO
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Zip | 65301-2111
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Country | US
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Telephone | 660-827-0000
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Fax | 660-826-3525
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Authorized Official
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Title or Position | OWNER
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Name | JOHN D KNORP
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Credential | RPH.
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Telephone | 660-221-2735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 005611
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State | NULL
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