Provider Demographics
NPI:1942522214
Name:MAIDA, LAURA FRANCES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:FRANCES
Last Name:MAIDA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BOB FERRELL CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9049
Mailing Address - Country:US
Mailing Address - Phone:732-866-4384
Mailing Address - Fax:
Practice Address - Street 1:4363 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3819
Practice Address - Country:US
Practice Address - Phone:718-967-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039700183500000X
NJ28RI03048400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist