Provider Demographics
NPI:1548272248
Name:MAISTER, JAMES MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:MAISTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 DIAMONDS PALM LOOP
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7159
Mailing Address - Country:US
Mailing Address - Phone:813-545-9446
Mailing Address - Fax:
Practice Address - Street 1:1395 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3790
Practice Address - Country:US
Practice Address - Phone:727-942-5030
Practice Address - Fax:727-942-5085
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS34202OtherFL PHARMACIST LICENSE