Provider Demographics
NPI:1821032343
Name:PLAZA PHARMACY
Entity Type:Organization
Organization Name:PLAZA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:MR
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-222-0808
Mailing Address - Street 1:2818A KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3902
Mailing Address - Country:US
Mailing Address - Phone:201-222-0808
Mailing Address - Fax:201-222-7747
Practice Address - Street 1:2818A KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3902
Practice Address - Country:US
Practice Address - Phone:201-222-0808
Practice Address - Fax:201-222-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00541400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========Medicare UPIN