Healthcare Provider Details

I. General information

NPI: 1194736744
Provider Name (Legal Business Name): MAY MAPLE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 CENTRAL AVE SE STE B
ALBUQUERQUE NM
87108-2050
US

IV. Provider business mailing address

7010 CENTRAL AVE SE STE B
ALBUQUERQUE NM
87108-2050
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-6111
  • Fax: 505-255-6656
Mailing address:
  • Phone: 505-255-6111
  • Fax: 505-255-6656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH00003104
License Number StateNM

VIII. Authorized Official

Name: CONNIE TSUI
Title or Position: PRESIDENT / OWNER
Credential: PHRM D
Phone: 505-828-2348