Organization
PROFESSIONAL PLAZA PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ADETULA RPH, PHD (CHIEF PHARMACIST)
(972) 572-1939
Entity
Organization
Contact information
Practice address
1005 YORK DR, SUITE 105, DESOTO, TX 75115-2083
(972) 572-1939
(972) 572-9990
Mailing address
1005 YORK DR, SUITE 105, DESOTO, TX 75115-2083
(972) 572-1939
(972) 572-9990
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
1313330001
TX
3336C0003X
Community/Retail Pharmacy
Primary
19614
TX
335E00000X
Prosthetic/Orthotic Supplier
19614
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011191601
—
TX
05
—
011191602
—
TX
05
—
144861
—
TX
01
—
4509165
NABP
TX
Enumeration date
01/19/2007
Last updated
06/17/2008
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