Organization
MAPLE MOUNTAIN PHARMACY INC.
Active
Other names
Maple Mountain Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL JOHNSON (OWNER/PRESIDENT)
(801) 885-1147
Entity
Organization
Contact information
Practice address
724 S 1600 W, MAPLETON, UT 84664-4347
(801) 515-6048
Mailing address
724 S 1600 W, MAPLETON, UT 84664-4347
(801) 515-6048
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
8359109-1703
UT
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167468
PK
—
Enumeration date
02/08/2017
Last updated
02/08/2017
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