Provider Demographics
NPI:1326673781
Name:PLAZA, ALVARO MARCIAL JR (RPH)
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:MARCIAL
Last Name:PLAZA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-1598
Mailing Address - Country:US
Mailing Address - Phone:559-637-0003
Mailing Address - Fax:
Practice Address - Street 1:1109 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-1598
Practice Address - Country:US
Practice Address - Phone:559-637-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81536183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist