Provider Demographics
NPI:1497039853
Name:GRAND PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:GRAND PLAZA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRODZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-447-8277
Mailing Address - Street 1:965 BRISTOL PIKE
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-8142
Mailing Address - Country:US
Mailing Address - Phone:215-447-8277
Mailing Address - Fax:
Practice Address - Street 1:965 BRISTOL PIKE
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-8142
Practice Address - Country:US
Practice Address - Phone:215-447-8277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy