Plaza Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PLAZA PHARMACY INC

Practice address

828 Walnut St
Coffeyville, KS 67337-5826

Phone

(620) 251-2050

Fax

(620) 251-2051

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Richard Bauer, PHRM

Title

Pic

Phone

(620) 251-2050

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1639245731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1355",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673370931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "828 WALNUT ST",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673375826",
            "telephone_number": "620-251-2050",
            "fax_number": "620-251-2051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLAZA PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "620-251-2050",
        "authorized_official_credential": "PHRM"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "KS",
            "license": "205074",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100436840B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1701879",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barry Curtis Phillips, N.P.-C
• Larry D Phipps, CRNA
• PHS KS Moirai LLC
• PHS KS Moirai LLC
• Carrie Ann Pitts
• Heather Lee Pollet, APRN
• Jimmy Lee Powell
• Terry Douglas Powell, MD
• Prescription Shop Inc
• Prescription Shop, Inc

• Community/Retail Pharmacy in Coffeyville, KS
• Providers in Coffeyville, KS by specialty
• Community/Retail Pharmacy in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.