Provider Demographics
NPI:1770679714
Name:PLAZA PHARMACY, INC
Entity Type:Organization
Organization Name:PLAZA PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:MARIRE
Authorized Official - Last Name:NEMECHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-276-8251
Mailing Address - Street 1:911 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5400
Mailing Address - Country:US
Mailing Address - Phone:620-276-8251
Mailing Address - Fax:620-275-2804
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5400
Practice Address - Country:US
Practice Address - Phone:620-276-8251
Practice Address - Fax:620-275-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2-100013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1702477OtherNABP
KS50039OtherBC/BS
KS100439180Medicaid
KS4885OtherBC/BS DME
KS1702477OtherNABP