# LA PLATA PHARMACY LLC

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

## Provider details

- **NPI number:** 1497254809
- **Authorized official:** JAMIE PROKUP (OWNER)
- **Authorized official phone:** (660) 346-0449

## Contact information

- **Practice address:** 221 N MACON ST, BEVIER, MO 63532-1058
- **Practice address phone:** (660) 346-0449
- **Practice address fax:** (660) 773-5529
- **Mailing address:** 221 N. MACON STREET, BEVIER, MO 63532
- **Mailing address phone:** (660) 346-0449
- **Mailing address fax:** (660) 773-5529

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 2018004056 | MO | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | — | — |
| 3336L0003X | Long Term Care Pharmacy | — | — | — |

## Other

- **Enumeration date:** 02/12/2018
- **Last updated:** 04/20/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2175841 | PK | — |
| 05 | — | 600133003 | — | MO |