Provider Demographics
NPI:1508334376
Name:MAPLEWOOD WELLNESS PHARMACY INC
Entity Type:Organization
Organization Name:MAPLEWOOD WELLNESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-605-1775
Mailing Address - Street 1:904 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-4438
Mailing Address - Country:US
Mailing Address - Phone:781-605-1775
Mailing Address - Fax:
Practice Address - Street 1:904 SALEM ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-4438
Practice Address - Country:US
Practice Address - Phone:781-605-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy