NPIViewer - Provider NPI 1861408338

NPI:	1861408338
Name:	PLAZA PHARMACY, INC
Entity type:	Organization
Organization Name:	PLAZA PHARMACY, INC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	OWNER
Authorized Official - Prefix:	MR
Authorized Official - First Name:	GIANPAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:	CIANCIMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	877-770-4422
Mailing Address - Street 1:	4399 NW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:	CORAL SPRINGS
Mailing Address - State:	FL
Mailing Address - Zip Code:	33065-7634
Mailing Address - Country:	US
Mailing Address - Phone:	877-770-4422
Mailing Address - Fax:	954-728-5505
Practice Address - Street 1:	4399 NW 124TH AVE
Practice Address - Street 2:
Practice Address - City:	CORAL SPRINGS
Practice Address - State:	FL
Practice Address - Zip Code:	33065-7634
Practice Address - Country:	US
Practice Address - Phone:	877-770-4422
Practice Address - Fax:	954-752-8805
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-08-01
Last Update Date:	2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:

State	License ID	Taxonomies
FL	PH26083	3336C0003X
FL	1313348	332B00000X

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

State	Identifier ID	ID Type	Issuer
MO	1861408338	Medicaid
AR	184810741	Medicaid
SC	1861408338	Medicaid
WA	1861408338	Medicaid
WI	1861408338	Medicaid
CO	65836073	Medicaid
ID	DME16508	Other	IDAHO STATE BOARD OF PHARMACY
GA	003108720A	Medicaid
DE	1861408338	Medicaid
HI	1861408338	Medicaid
MN	1861408338	Medicaid
NV	1861408338	Medicaid
OH	3118629	Medicaid
AR	MG01127	Other	ARKANSAS STATE DME LICENSE
ME	1861408338	Medicaid
MT	1861408338	Medicaid
WY	1861408338	Medicaid
ND	55753	Medicaid
KY	7100138990	Medicaid
RI	7470001	Medicaid
AZ	P013538	Other	ARIZONA STATE BOARD OF PHARMACY
IA	1861408338	Medicaid
MI	1861408338	Medicaid
CA	2009539	Medicaid
LA	2134639	Medicaid
AZ	569954	Medicaid
VT	1018685	Medicaid
AL	122917	Medicaid
TN	1521687	Medicaid
NM	1861408338	Medicaid
SD	1861408338	Medicaid
VA	1861408338	Medicaid
IN	201015170A	Medicaid
MD	420474300	Medicaid
NV	MP00639	Other	NEVADA STATE BOARD OF PHARMACY
KS	200698380A	Medicaid
CA	52668	Other	DEPARTMENT OF PUBLIC HEALTH , FOOD AND DRUG BRANCH
CT	CSW.0002763	Other	STATE OF CONNECTICUT
OR	NPC-0003635	Other	OREGON BOARD OF PHARMACY
NE	10025906100	Medicaid
ID	1861408338	Medicaid
NY	1861408338	Medicaid
UT	1861408338	Medicaid
WV	3810019574	Medicaid
WA	603096940	Other	STATE OF WASHINGTON
UT	7859530-1708	Other	STATE OF UTAH DEPARTMENT OF COMMERCE
VA	1861408338	Medicaid
HI	1861408338	Medicaid