Provider Demographics
NPI:1063487478
Name:MAPLE GARDENS PHARMACY
Entity Type:Organization
Organization Name:MAPLE GARDENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:RASIK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:973-374-5860
Mailing Address - Street 1:3 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3622
Mailing Address - Country:US
Mailing Address - Phone:973-374-5860
Mailing Address - Fax:973-374-5862
Practice Address - Street 1:3 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3622
Practice Address - Country:US
Practice Address - Phone:973-374-5860
Practice Address - Fax:973-374-5862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRS00658000333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy