Provider Demographics
NPI:1548499643
Name:NORTHEAST PHARMACY INC
Entity type:Organization
Organization Name:NORTHEAST PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UREJI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-344-4111
Mailing Address - Street 1:4576 MORSE CENTRE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6602
Mailing Address - Country:US
Mailing Address - Phone:614-344-4111
Mailing Address - Fax:614-467-2009
Practice Address - Street 1:4576 MORSE CENTRE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6602
Practice Address - Country:US
Practice Address - Phone:614-344-4111
Practice Address - Fax:614-467-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6578480001Medicare NSC