Healthcare Provider Details

I. General information

NPI: 1750772273
Provider Name (Legal Business Name): MAPLE ROSE ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD STE B-024
DENVER CO
80222-3303
US

IV. Provider business mailing address

2079 ALBION ST
DENVER CO
80207-3705
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-3613
  • Fax: 303-388-6182
Mailing address:
  • Phone: 303-320-0495
  • Fax: 303-388-5507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number168-87
License Number StateCO

VIII. Authorized Official

Name: TONY JONES
Title or Position: PRESIDENT
Credential:
Phone: 303-388-1674