Provider Demographics
NPI:1235501560
Name:JORDAN J MASWOSWE
Entity Type:Organization
Organization Name:JORDAN J MASWOSWE
Other - Org Name:MASWOSWE'S ALTERNATIVE PHARMACY SERVICES - MAPS RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASWOSWE
Authorized Official - Suffix:
Authorized Official - Credentials:PHRMD
Authorized Official - Phone:713-446-6826
Mailing Address - Street 1:10411 VETERANS MEMORIAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038-1501
Mailing Address - Country:US
Mailing Address - Phone:832-761-7817
Mailing Address - Fax:832-761-7821
Practice Address - Street 1:10411 VETERANS MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77038-1501
Practice Address - Country:US
Practice Address - Phone:832-761-7817
Practice Address - Fax:832-761-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX224913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147144Medicaid
2095969OtherPK