Organization
PLAZA DRUG OF LONDON LLC
Active
Other names
Plaza Drug of London
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE SIZEMORE (OWNER/PRESIDENT)
(606) 657-5245
Entity
Organization
Contact information
Practice address
731 N LAUREL RD, LONDON, KY 40741-6025
(606) 657-5245
(606) 657-5382
Mailing address
PO BOX 202, PITTSBURG, KY 40755-0202
(606) 657-5245
(606) 657-5382
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
P07655
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164322
PK
—
05
—
7100281580
—
KY
05
—
7100430090
—
KY
Enumeration date
09/26/2016
Last updated
02/28/2017
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