Maple Rose Enterprises

Primary specialty

Compounding PharmacyTaxonomy code 3336C0004X

License

168-87 Issued in CO

Legal business name

MAPLE ROSE ENTERPRISES

Doing business as

Pencol Compouding Pharmacy

Practice address

1325 S Colorado Blvd
Ste B-024
Denver, CO 80222-3303

Phone

(303) 388-3613

Fax

(303) 388-6182

NPI assigned

Feb 6, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tony Jones

Title

President

Phone

(303) 388-1674

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pencol Compouding Pharmacy Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1423180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423180800000",
    "number": "1750772273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2079 ALBION ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802073705",
            "telephone_number": "303-320-0495",
            "fax_number": "303-388-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S COLORADO BLVD",
            "address_2": "STE B-024",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802223303",
            "telephone_number": "303-388-3613",
            "fax_number": "303-388-6182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE ROSE ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-06",
        "last_updated": "2015-02-06",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-388-1674"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "CO",
            "license": "168-87",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2150138",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pencol Compouding Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dan L Manzanares, PSY.D.
• Rhiannon Manzanares
• Denisse Manzano de la Campa, MA
• Abigail Manzano
• Clarissa Manzi, PHARMD
• Maple Star Colorado
• Maple Star Colorado Dba Clarvida
• Maple Star Colorado Dba Clarvida
• Maple Star Colorado Dba Clarvida
• Maple Street ABA Co LLC

• Compounding Pharmacy in Denver, CO
• Providers in Denver, CO by specialty
• Compounding Pharmacy in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.