Organization
PLAZA PHARMACY INC
Active
Organization
PLAZA PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BAUER PHRM (PIC)
(620) 251-2050
Entity
Organization
Contact information
Practice address
828 WALNUT ST, COFFEYVILLE, KS 67337-5826
(620) 251-2050
(620) 251-2051
Mailing address
PO BOX 1355, COFFEYVILLE, KS 67337-0931
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
205074
KS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100436840B
—
KS
01
—
1701879
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
11/28/2006
Last updated
10/10/2007
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