Provider Demographics
NPI:1366069965
Name:PLAZA PHARMACY LLC
Entity type:Organization
Organization Name:PLAZA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUSELAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:517-599-4634
Mailing Address - Street 1:1138 N GERMANTOWN PKWY
Mailing Address - Street 2:STE 101 # 425
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3024 COVINGTON PIKE STE 5
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5043
Practice Address - Country:US
Practice Address - Phone:901-779-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy