Provider Demographics
NPI:1457530735
Name:NORTHRIDGE PLAZA PHARMACY INC.
Entity Type:Organization
Organization Name:NORTHRIDGE PLAZA PHARMACY INC.
Other - Org Name:SMP PHARMACY SOLUTIONS #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:QUALITY & PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-740-9720
Mailing Address - Street 1:7425 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4402
Mailing Address - Country:US
Mailing Address - Phone:305-740-9696
Mailing Address - Fax:818-998-8730
Practice Address - Street 1:18546 ROSCOE BLVD.
Practice Address - Street 2:#102
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324
Practice Address - Country:US
Practice Address - Phone:818-998-8700
Practice Address - Fax:818-998-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066993OtherPK
CAPHA393410Medicaid
1033780001Medicare NSC