Provider Demographics
NPI:1003857723
Name:PLAZA DRUGS INC
Entity Type:Organization
Organization Name:PLAZA DRUGS INC
Other - Org Name:PLAZA DRUGS AND MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:201-863-1044
Mailing Address - Street 1:3800 NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-863-1044
Mailing Address - Fax:201-863-1699
Practice Address - Street 1:3800 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-863-1044
Practice Address - Fax:201-863-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00672200332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099431Medicaid
NJ5255890001Medicare NSC