Provider Demographics
NPI:1588831812
Name:MAAF CORP
Entity Type:Organization
Organization Name:MAAF CORP
Other - Org Name:NORTHEAST PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IHSANULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-771-7026
Mailing Address - Street 1:9867 COWDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6730 BUSTLETON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2301
Practice Address - Country:US
Practice Address - Phone:215-771-7026
Practice Address - Fax:215-333-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4818383336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3990404OtherOTHER ID NUMBER