Provider Demographics
NPI:1770669988
Name:MAIDA PHARMACY INC
Entity Type:Organization
Organization Name:MAIDA PHARMACY INC
Other - Org Name:MAIDA PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHCST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:781-643-7840
Mailing Address - Street 1:121 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8615
Mailing Address - Country:US
Mailing Address - Phone:781-643-7840
Mailing Address - Fax:781-643-0174
Practice Address - Street 1:121 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8615
Practice Address - Country:US
Practice Address - Phone:781-643-7840
Practice Address - Fax:781-643-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MADS28223336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0497673Medicaid
2038563OtherPK