Organization Name: | MAPLE MOUNTAIN PHARMACY INC |
NPI Number: | 1457603037 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL JOHNSON (PRESIDENT/OWNER/PIC) |
Mailing Address: | 724 S 1600 W Mapleton |
State: | UT US |
Postal Code: | 846644342 |
Phone Number: | 8015156048 |
Fax Number: | 8558485748 |
NPI Enumeration Date: | 10/08/2012 |
NPI Last Update Date: | 04/22/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |