Provider Demographics
NPI:1578654638
Name:PLAS, ANTHONY JAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JAY
Last Name:PLAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 BALDWIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3412
Mailing Address - Country:US
Mailing Address - Phone:248-693-9290
Mailing Address - Fax:
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-693-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302032435OtherPHARMACIST LICENSE