Provider Demographics
NPI:1568566529
Name:PLATEAU DRUGS INC
Entity Type:Organization
Organization Name:PLATEAU DRUGS INC
Other - Org Name:PLATEAU DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-565-5555
Mailing Address - Street 1:PO BOX 4438
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4438
Mailing Address - Country:US
Mailing Address - Phone:423-569-5555
Mailing Address - Fax:423-569-8805
Practice Address - Street 1:18157 ALBERTA ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6201
Practice Address - Country:US
Practice Address - Phone:423-569-5555
Practice Address - Fax:423-569-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN2333336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033350Medicaid
2094807OtherPK