Provider Demographics
NPI:1023154168
Name:LAPLATA PHARMACY
Entity type:Organization
Organization Name:LAPLATA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-332-4456
Mailing Address - Street 1:29936 JULY RD
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MO
Mailing Address - Zip Code:63549-3129
Mailing Address - Country:US
Mailing Address - Phone:660-332-4456
Mailing Address - Fax:660-332-4429
Practice Address - Street 1:29936 JULY RD
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MO
Practice Address - Zip Code:63549-3129
Practice Address - Country:US
Practice Address - Phone:660-332-4456
Practice Address - Fax:660-332-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPS0060883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6716990001Medicare NSC