Provider Demographics
NPI:1083937551
Name:MAPLE KNOLL PHARMACY
Entity Type:Organization
Organization Name:MAPLE KNOLL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-782-2550
Mailing Address - Street 1:3699 SYMMES RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1370
Mailing Address - Country:US
Mailing Address - Phone:513-632-7960
Mailing Address - Fax:513-874-8000
Practice Address - Street 1:3699 SYMMES RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1370
Practice Address - Country:US
Practice Address - Phone:513-632-7960
Practice Address - Fax:513-874-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0220301003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy