Provider Demographics
NPI:1841397262
Name:MAIDA, PETER JOSEPH
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:MAIDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:NORVELT
Mailing Address - State:PA
Mailing Address - Zip Code:15674-0200
Mailing Address - Country:US
Mailing Address - Phone:724-423-4100
Mailing Address - Fax:724-824-8082
Practice Address - Street 1:2310 MT PLEASANT ROAD
Practice Address - Street 2:
Practice Address - City:NORVELT
Practice Address - State:PA
Practice Address - Zip Code:15674
Practice Address - Country:US
Practice Address - Phone:724-423-4100
Practice Address - Fax:724-424-8082
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037533L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist