PROFESSIONAL PLAZA PHARMACY, INC – Community/Retail Pharmacy, NPI 1316958804
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for PROFESSIONAL PLAZA PHARMACY, INC
2065 N ROBBINS DR
LAYTON, UT 840411133
Phone: (801) 773-3863
Fax: (801) 773-3892
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-10-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (956 days ago).
Enrollment records
1
Earliest due date
2023-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20171030002965 | O | Mass Immunization (Roster Biller Only) | UT | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 57 | 57 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 47 | 47 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 36 | 36 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 36 | 36 | $0 |
Insurance plans in this area (ZIP 84041)
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