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Organization
MAPLE MOUNTAIN PHARMACY INC
Active
Organization
MAPLE MOUNTAIN PHARMACY INC
Active
Other names
Maple Mountain Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHNSON (PRESIDENT/OWNER/PIC)
(801) 885-1147
Entity
Organization
Contact information
Practice address
724 S 1600 W, MAPLETON, UT 84664-4342
(801) 515-6048
(855) 848-5748
Mailing address
724 S 1600 W, MAPLETON, UT 84664-4342
(801) 515-6048
(855) 848-5748
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8359109-1703
UT
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457603037
—
UT
01
—
2137217
PK
—
Enumeration date
10/08/2012
Last updated
04/22/2014
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