Provider Demographics
NPI:1194716548
Name:MAPLEWOOD CHEMISTS, INC
Entity type:Organization
Organization Name:MAPLEWOOD CHEMISTS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/V.P
Authorized Official - Prefix:MR
Authorized Official - First Name:SASHI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DONDAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-762-2700
Mailing Address - Street 1:747 IRVINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1607
Mailing Address - Country:US
Mailing Address - Phone:973-762-2700
Mailing Address - Fax:973-762-6002
Practice Address - Street 1:747 IRVINGTON AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-1607
Practice Address - Country:US
Practice Address - Phone:973-762-2700
Practice Address - Fax:973-762-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006881003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3130464OtherNCPDP
NJ0220663Medicaid
NJ0220663Medicaid