Provider Information for 1972557171
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EASTSIDE PHARMACY, INC.
Other Names:Doing Business As:EAST SIDE PHARMACYOrganization Subpart: NO
NPI: 1972557171
Last Updated: 2024-03-26
Certification Date: 2024-03-26
Certification Date: 2024-03-26
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1972557171 | ||||||||||||||||||||
| Enumeration Date | 2006-05-20 | ||||||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Authorized Official Information | Name: Mr. STEPHEN KENNEDY ROWLAND RPh Title: Pharmacist/Owner Phone: 5736867238 | ||||||||||||||||||||
| Mailing Address | 400 E PINE ST POPLAR BLUFF, MO 63901-5401 United States Phone: 573-686-7238 | Fax:573-686-7239 | ||||||||||||||||||||
| Primary Practice Address | 400 E PINE ST POPLAR BLUFF, MO 63901-5401 United States Phone: 573-686-7238 | Fax:573-686-7239 | ||||||||||||||||||||
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