# PLAZA LTC PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336208727
- **Authorized official:** MR. EDWARD M SHIBLEY JR. RPH, MBA (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (804) 864-0276

## Contact information

- **Practice address:** 1717 BELLEVUE AVE APT A605, RICHMOND, VA 23227-3936
- **Practice address phone:** (804) 864-0276
- **Practice address fax:** (804) 864-0275
- **Mailing address:** 1717 BELLEVUE AVE APT A605, RICHMOND, VA 23227-3936
- **Mailing address phone:** (804) 864-0276
- **Mailing address fax:** (804) 864-0275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 0201003958 | VA | Yes |

## Other

- **Enumeration date:** 12/08/2006
- **Last updated:** 02/29/2008