Provider Demographics
NPI:1750372223
Name:MEDICAL PLAZA PHARMACY
Entity type:Organization
Organization Name:MEDICAL PLAZA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DENINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD RPH
Authorized Official - Phone:319-337-3966
Mailing Address - Street 1:540 E JEFFERSON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-2477
Mailing Address - Country:US
Mailing Address - Phone:319-337-3966
Mailing Address - Fax:
Practice Address - Street 1:540 E JEFFERSON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2477
Practice Address - Country:US
Practice Address - Phone:319-337-3966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0014225Medicaid
IA0195950001Medicare ID - Type Unspecified