Provider Demographics
NPI:1366550725
Name:WESTLAND MAPLE DRUGS INC.
Entity type:Organization
Organization Name:WESTLAND MAPLE DRUGS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANVASSER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-729-2200
Mailing Address - Street 1:1949 N. WAYNE RD.
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185
Mailing Address - Country:US
Mailing Address - Phone:734-729-2200
Mailing Address - Fax:734-729-3857
Practice Address - Street 1:1949 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185
Practice Address - Country:US
Practice Address - Phone:734-729-2200
Practice Address - Fax:734-729-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010015503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2334681OtherOTHER ID NUMBER
MI2334681Medicaid
MI2334681Medicaid