Provider Demographics
NPI:1467445569
Name:GAINESVILLE PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:GAINESVILLE PLAZA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEECE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:940-665-8401
Mailing Address - Street 1:411 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76240-4323
Mailing Address - Country:US
Mailing Address - Phone:940-665-8401
Mailing Address - Fax:940-665-4102
Practice Address - Street 1:411 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-4323
Practice Address - Country:US
Practice Address - Phone:940-665-8401
Practice Address - Fax:940-665-4102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16354333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157516902Medicaid
TX157516902Medicaid
TX1189350001Medicare NSC