Provider Demographics
NPI:1275070872
Name:MAPLE PHARMACY LLC
Entity Type:Organization
Organization Name:MAPLE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MASAYDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-969-4400
Mailing Address - Street 1:697 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1856
Mailing Address - Country:US
Mailing Address - Phone:860-969-4400
Mailing Address - Fax:860-904-2092
Practice Address - Street 1:697 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1856
Practice Address - Country:US
Practice Address - Phone:860-969-4400
Practice Address - Fax:860-904-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-21
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CTPCY.00023483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167897OtherPK