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General NPI Number Information
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NPI Number | 1275070872
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Entity Type | Organization
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Legal Business Name | MAPLE PHARMACY LLC
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Dates
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Enumeration Date | 01/21/2017
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 697 MAPLE AVE
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City | HARTFORD
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State | CT
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Zip | 06114-1856
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Country | US
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Telephone | 860-969-4400
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Fax | 860-904-2092
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Provider Business Mailing Address
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Address Line | 697 MAPLE AVE
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City | HARTFORD
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State | CT
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Zip | 06114-1856
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Country | US
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Telephone | 860-969-4400
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Fax | 860-904-2092
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHARON MASAYDA
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Credential |
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Telephone | 860-969-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY.0002348
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License Number State | CT
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