Provider Demographics
NPI:1053285676
Name:MAPLEWOOD VILLAGE PHARMACY LLC
Entity type:Organization
Organization Name:MAPLEWOOD VILLAGE PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-515-7676
Mailing Address - Street 1:101 BAKER ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2782
Mailing Address - Country:US
Mailing Address - Phone:732-234-0050
Mailing Address - Fax:732-234-0049
Practice Address - Street 1:101 BAKER ST UNIT B
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2782
Practice Address - Country:US
Practice Address - Phone:732-234-0050
Practice Address - Fax:732-234-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy