Provider Demographics
NPI:1366107450
Name:EAST PARK PHARMACY INC
Entity type:Organization
Organization Name:EAST PARK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JON-UBABUCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-422-1777
Mailing Address - Street 1:1115 BENTWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6920
Mailing Address - Country:US
Mailing Address - Phone:817-422-1777
Mailing Address - Fax:817-962-0958
Practice Address - Street 1:918 E PARK ROW DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-4507
Practice Address - Country:US
Practice Address - Phone:817-617-2069
Practice Address - Fax:817-962-0958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy