Provider Demographics
NPI:1881988152
Name:CROSS, MAGGIE JEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:JEAN
Last Name:CROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4589
Mailing Address - Country:US
Mailing Address - Phone:860-798-6042
Mailing Address - Fax:203-634-6060
Practice Address - Street 1:474 CHAMBERLAIN HWY
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-1818
Practice Address - Country:US
Practice Address - Phone:203-634-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10308183500000X
MA26241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist