Provider Demographics
NPI:1285625376
Name:IPLAZA PHARMACY, INC.
Entity type:Organization
Organization Name:IPLAZA PHARMACY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:310-530-3010
Mailing Address - Street 1:3400 LOMITA BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4909
Mailing Address - Country:US
Mailing Address - Phone:310-530-3010
Mailing Address - Fax:310-530-7618
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:STE 102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4909
Practice Address - Country:US
Practice Address - Phone:310-530-3010
Practice Address - Fax:310-530-7618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IPLAZA PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-29
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0554293OtherNCPDP PROVIDER IDENTIFICATION NUMBER
0554293OtherNCPDP PROVIDER IDENTIFICATION NUMBER