Provider Demographics
NPI:1336446376
Name:PARK PLAZA PHARMA INC.
Entity Type:Organization
Organization Name:PARK PLAZA PHARMA INC.
Other - Org Name:PARK PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST AND VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-583-5900
Mailing Address - Street 1:1773 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-583-5900
Mailing Address - Fax:718-716-1876
Practice Address - Street 1:1773 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6961
Practice Address - Country:US
Practice Address - Phone:718-583-5900
Practice Address - Fax:718-716-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6570880001Medicare NSC