Provider Demographics
NPI:1821002320
Name:PACIFIC PLAZA PHARMACY,INC.
Entity Type:Organization
Organization Name:PACIFIC PLAZA PHARMACY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NAGI
Authorized Official - Middle Name:M
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-426-6588
Mailing Address - Street 1:2777 PACIFIC AVE
Mailing Address - Street 2:SUITE-A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2625
Mailing Address - Country:US
Mailing Address - Phone:562-426-6588
Mailing Address - Fax:652-426-6580
Practice Address - Street 1:2777 PACIFIC AVE
Practice Address - Street 2:SUITE-A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2625
Practice Address - Country:US
Practice Address - Phone:562-426-6588
Practice Address - Fax:652-426-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5523390001332B00000X
CAPHY449053336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA449050Medicaid
CAPHA449050Medicaid