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Organization
PLAZA PHARMACY INC
Active
Organization
PLAZA PHARMACY INC
Active
Other names
PLAZA PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CLARK (PRESIDENT)
(228) 762-1940
Entity
Organization
Contact information
Practice address
4211 HOSPITAL ST, STE 104, PASCAGOULA, MS 39581-5320
(228) 762-1940
(228) 762-1940
Mailing address
4211 HOSPITAL ST, STE 104, PASCAGOULA, MS 39581-5320
(228) 762-1940
(228) 762-7786
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
01129/1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0030278
—
MS
01
—
2043339
PK
—
Enumeration date
12/06/2006
Last updated
08/09/2019
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