# MAPLE MOUNTAIN PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maple Mountain Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457603037
- **Authorized official:** MICHAEL JOHNSON (PRESIDENT/OWNER/PIC)
- **Authorized official phone:** (801) 885-1147

## Contact information

- **Practice address:** 724 S 1600 W, MAPLETON, UT 84664-4342
- **Practice address phone:** (801) 515-6048
- **Practice address fax:** (855) 848-5748
- **Mailing address:** 724 S 1600 W, MAPLETON, UT 84664-4342
- **Mailing address phone:** (801) 515-6048
- **Mailing address fax:** (855) 848-5748

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8359109-1703 | UT | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/08/2012
- **Last updated:** 04/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1457603037 | — | UT |
| 01 | — | 2137217 | PK | — |