MEDICARE: MAPLE GARDENS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	RS00658000	NJ

General Provider Information

NPI Number	:	1063487478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE GARDENS PHARMACY

Provider Business Mailing Address
First Line	:	3 MARSHALL ST
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3622
Country	:	US
Telephone Number	:	973-374-5860
Fax Number	:	973-374-5862

Provider Business Practice Location Address
First Line	:	3 MARSHALL ST
Second Line	:
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3622
Country	:	US
Telephone Number	:	973-374-5860
Fax Number	:	973-374-5862

Authorized Official
Title or Position	:	RPH IN-CHARGE
Name	:	RASIK L PATEL
Credential	:	PHARM D.
Telephone Number	:	973-374-5860

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	08/22/2020

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