Healthcare Provider Details

I. General information

NPI: 1063487478
Provider Name (Legal Business Name): MAPLE GARDENS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARSHALL ST
IRVINGTON NJ
07111-3622
US

IV. Provider business mailing address

3 MARSHALL ST
IRVINGTON NJ
07111-3622
US

V. Phone/Fax

Practice location:
  • Phone: 973-374-5860
  • Fax: 973-374-5862
Mailing address:
  • Phone: 973-374-5860
  • Fax: 973-374-5862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberRS00658000
License Number StateNJ

VIII. Authorized Official

Name: RASIK L PATEL
Title or Position: RPH IN-CHARGE
Credential: PHARM D.
Phone: 973-374-5860