NPIMap

Organization Active NPI

Professional Plaza Pharmacy Inc

  • Community/Retail Pharmacy
  • Desoto, TX
National Provider Identifier
1295888394
Registry record updated Jun 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
19614 Issued in TX
Legal business name
PROFESSIONAL PLAZA PHARMACY INC
Practice address
1005 York Dr
Suite 105
Desoto, TX 75115-2083
Phone
(972) 572-1939
Fax
(972) 572-9990
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Adetula, RPH, PHD
Title
Chief Pharmacist
Phone
(972) 572-1939

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1313330001 TX
Community/Retail Pharmacy 3336C0003X 19614 TX Primary
Prosthetic/Orthotic Supplier 335E00000X 19614 TX

Addresses

Primary practice location

1005 York Dr
Suite 105
Desoto, TX 75115-2083

Mailing address

1005 York Dr
Suite 105
Desoto, TX 75115-2083
Phone (972) 572-1939

Other identifiers 4

IdentifierTypeStateIssuer
011191602MedicaidTX
144861MedicaidTX
4509165OtherTXNABP
011191601MedicaidTX

National Provider Directory

National Provider Directory

Locations

1005 York Dr
#105
Desoto, TX 75115
Phone (972) 572-1939

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213660800000",
    "number": "1295888394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 YORK DR",
            "address_2": "SUITE 105",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152083",
            "telephone_number": "972-572-1939",
            "fax_number": "972-572-9990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 YORK DR",
            "address_2": "SUITE 105",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152083",
            "telephone_number": "972-572-1939",
            "fax_number": "972-572-9990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PLAZA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2008-06-17",
        "status": "A",
        "authorized_official_last_name": "ADETULA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "972-572-1939",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "RPH, PHD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "1313330001",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "19614",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TX",
            "license": "19614",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011191602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144861",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "4509165",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "011191601",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Desoto, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.