Healthcare Provider Details

I. General information

NPI: 1750198826
Provider Name (Legal Business Name): MAXIPHARMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10614 ASTORIA BLVD
FLUSHING NY
11369-2047
US

IV. Provider business mailing address

10614 ASTORIA BLVD
FLUSHING NY
11369-2047
US

V. Phone/Fax

Practice location:
  • Phone: 929-424-3877
  • Fax: 929-424-3876
Mailing address:
  • Phone: 929-424-3877
  • Fax: 929-424-3876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEAN CARLOS RAMOS RONDON
Title or Position: OWNER / GENERAL MANAGER
Credential:
Phone: 929-499-7406