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General NPI Number Information
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NPI Number | 1720537251
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Entity Type | Organization
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Legal Business Name | PLAZA DRUG OF LONDON LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 731 N LAUREL RD
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City | LONDON
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State | KY
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Zip | 40741-6025
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Country | US
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Telephone | 606-657-5245
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Fax | 606-657-5382
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Provider Business Mailing Address
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Address Line | PO BOX 202
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City | PITTSBURG
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State | KY
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Zip | 40755-0202
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Country | US
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Telephone | 606-657-5245
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Fax | 606-657-5382
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MIKE SIZEMORE
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Credential |
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Telephone | 606-657-5245
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | P07655
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License Number State | KY
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