Maple Avenue Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY006500 Issued in LA

Legal business name

MAPLE AVENUE PHARMACY INC

Doing business as

Maple Avenue Pharmacy

Practice address

1200 W Maple Ave
Eunice, LA 70535-4320

Phone

(337) 457-5216

Fax

(337) 457-0920

NPI assigned

Oct 7, 2006

Last updated

Sep 28, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

August CourvilleNPI 1932416534

Title

Owner/Pic

Phone

(337) 580-1485

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Maple Avenue Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• August Courville Jr.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Eunice, LA
  • NPI 1932416534
  NPD (past) Authorized official
• Christina Gayle Marcantel

  • Pharmacist
  • Eunice, LA
  • NPI 1366759755
  NPD (past)
• Cleveland Glynn Michaud Jr.

  • Pharmacist
  • Eunice, LA
  • NPI 1043527435
  NPD (past)

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

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475020800000",
    "number": "1982791174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1002",
            "city": "EUNICE",
            "state": "LA",
            "postal_code": "705351002",
            "telephone_number": "337-457-5216",
            "fax_number": "337-457-0920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W MAPLE AVE",
            "city": "EUNICE",
            "state": "LA",
            "postal_code": "705354320",
            "telephone_number": "337-457-5216",
            "fax_number": "337-457-0920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE AVENUE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2016-09-28",
        "status": "A",
        "authorized_official_last_name": "COURVILLE",
        "authorized_official_first_name": "AUGUST",
        "authorized_official_title_or_position": "OWNER/PIC",
        "authorized_official_telephone_number": "337-580-1485"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "LA",
            "license": "PHY006500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2201506",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2135863",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Avenue Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caroline M. Manuel, D.D.S.
• Jillian H Manuel, P.T.
• Kathy Lynn Manuel, LICENSED PROFESSIONA
• Monica West Manuel, M.S., CCC-SLP
• Sylvan J. Manuel Jr., RPH
• Christina Gayle Marcantel
• Lisa Marie Marks, M.S.
• Tina Marie Marks, M.S., CCC-SLP
• Crystal Gail Marshall
• Candase Miller Martel, LPC-S

• Community/Retail Pharmacy in Eunice, LA
• Providers in Eunice, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.