Active NPI
Plaza Pharmacy Inc
- Community/Retail Pharmacy
- Pascagoula, MS
National Provider Identifier
1295894293
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 01129/1.2
- Legal business name
- PLAZA PHARMACY INC
- Practice address
- 4211 Hospital St
Ste 104
Pascagoula, MS 39581-5320 - Phone
- (228) 762-1940
- Fax
- (228) 762-1940
- NPI assigned
- Dec 6, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenneth Clark
- Title
- President
- Phone
- (228) 762-1940
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 01129/1.2 | MS | Primary |
Addresses
Primary practice location
4211 Hospital St
Ste 104
Pascagoula, MS 39581-5320
Mailing address
4211 Hospital St
Ste 104
Pascagoula, MS 39581-5320
Phone (228) 762-1940
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2043339 | Other | PK | |
| 0030278 | Medicaid | MS |
Other names 1
- PLAZA PHARMACY INC
National Provider Directory
National Provider DirectoryLocations
4211 Hospital St
Ste 104
Pascagoula, MS 39581
Phone (228) 762-1940
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Pascagoula, MS
- NPI 1821119959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1565308800000",
"number": "1295894293",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4211 HOSPITAL ST",
"address_2": "STE 104",
"city": "PASCAGOULA",
"state": "MS",
"postal_code": "395815320",
"telephone_number": "228-762-1940",
"fax_number": "228-762-7786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4211 HOSPITAL ST",
"address_2": "STE 104",
"city": "PASCAGOULA",
"state": "MS",
"postal_code": "395815320",
"telephone_number": "228-762-1940",
"fax_number": "228-762-1940"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PLAZA PHARMACY INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-06",
"last_updated": "2019-08-09",
"status": "A",
"authorized_official_last_name": "CLARK",
"authorized_official_first_name": "KENNETH",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "228-762-1940"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MS",
"license": "01129/1.2",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2043339",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0030278",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PLAZA PHARMACY INC",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PLAZA PHARMACY INC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pascagoula, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.