Provider Demographics
NPI:1316562077
Name:MAGGIE'S PHARMACY INC
Entity Type:Organization
Organization Name:MAGGIE'S PHARMACY INC
Other - Org Name:MAGGIE'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NARE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:805-770-1001
Mailing Address - Street 1:2315 KUEHNER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3960
Mailing Address - Country:US
Mailing Address - Phone:805-770-1001
Mailing Address - Fax:805-770-1002
Practice Address - Street 1:2315 KUEHNER DR STE 107
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3960
Practice Address - Country:US
Practice Address - Phone:805-770-1001
Practice Address - Fax:805-770-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy