Provider Demographics
NPI:1720262926
Name:PARC PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:PARC PLAZA PHARMACY INC
Other - Org Name:US PHARMACY OF DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:KINYUY
Authorized Official - Last Name:NTARYIKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:214-228-6987
Mailing Address - Street 1:4801 S BUCKNER BLVD,
Mailing Address - Street 2:100
Mailing Address - City:DALLAS,
Mailing Address - State:TX
Mailing Address - Zip Code:75227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4801 S BUCKNER BLVD
Practice Address - Street 2:100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2373
Practice Address - Country:US
Practice Address - Phone:214-228-6987
Practice Address - Fax:214-228-6987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGOtherPHARMACY LICENSE NUMBER
TXPENDINGMedicaid