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A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Clinic Pharmacy |
3336C0002X | 58 | Medical Supply Company with Pharmacist | |
Community/Retail Pharmacy |
3336C0003X | 58 | Medical Supply Company with Pharmacist |
| NPI # | 1912064478 |
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| LBN Legal business name | MAPLE STREET CLINIC PHARMACY LLC | ||||||||||||||||
| Authorized official | CHRISTOPHER VORRATH - (PRES) | ||||||||||||||||
| Entity | Organization | ||||||||||||||||
| Organization subpart 1 | No | ||||||||||||||||
| Enumeration date | 01/03/2007 | ||||||||||||||||
| Last updated | 06/23/2008 - About 18 years ago | ||||||||||||||||
| Identifiers |
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MAPLE STREET CLINIC PHARMACY LLC