Provider Demographics
NPI:1942677083
Name:OLOFSON, MAPLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MAPLE
Middle Name:
Last Name:OLOFSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 AUTO CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6700
Mailing Address - Country:US
Mailing Address - Phone:909-599-3955
Mailing Address - Fax:
Practice Address - Street 1:1950 AUTO CENTRE DR
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6700
Practice Address - Country:US
Practice Address - Phone:909-599-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist