Provider Demographics
NPI:1720220304
Name:JORDAN J MASWOSWE
Entity Type:Organization
Organization Name:JORDAN J MASWOSWE
Other - Org Name:MASWOSWE'S ALTERNATIVE PHARMACY SERVICES (MAPSRX)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASWOSWE
Authorized Official - Suffix:
Authorized Official - Credentials:BSC, PHARMD
Authorized Official - Phone:713-446-6826
Mailing Address - Street 1:PO BOX 11556
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77391-1556
Mailing Address - Country:US
Mailing Address - Phone:713-446-6826
Mailing Address - Fax:832-553-7400
Practice Address - Street 1:6402 LOUETTA RD
Practice Address - Street 2:SUITE 145
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7580
Practice Address - Country:US
Practice Address - Phone:832-953-2782
Practice Address - Fax:832-953-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX254253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2119584OtherPK