Provider Demographics
NPI:1164832150
Name:PLAZA DRUGS
Entity Type:Organization
Organization Name:PLAZA DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELOY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARAGON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:505-425-5221
Mailing Address - Street 1:178 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-425-5221
Mailing Address - Fax:505-454-1077
Practice Address - Street 1:178 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-425-5221
Practice Address - Fax:505-454-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000002251835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18350000OtherNPI
NMF2708Medicaid