Provider Demographics
NPI:1669512257
Name:MAAG PRESCRIPTION CENTER L.L.C.
Entity type:Organization
Organization Name:MAAG PRESCRIPTION CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-233-2063
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-0115
Mailing Address - Country:US
Mailing Address - Phone:208-233-2063
Mailing Address - Fax:
Practice Address - Street 1:333 W CENTER ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3243
Practice Address - Country:US
Practice Address - Phone:208-233-2063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID526CP332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010014150OtherBLUE SHIELD OF ID
ID8589-4OtherBLUE CROSS OF IDAHO
ID000010014150OtherBLUE SHIELD OF ID