Provider Demographics
NPI:1154534279
Name:PLAZA DRUGS
Entity type:Organization
Organization Name:PLAZA DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-925-3575
Mailing Address - Street 1:12430 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-7608
Mailing Address - Country:US
Mailing Address - Phone:409-925-3574
Mailing Address - Fax:
Practice Address - Street 1:12430 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-7608
Practice Address - Country:US
Practice Address - Phone:409-925-3574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140840Medicaid