Provider Demographics
NPI:1962889568
Name:NORTH EAST PHARMACY INC
Entity type:Organization
Organization Name:NORTH EAST PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-674-8226
Mailing Address - Street 1:2316 PULASKI HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3730
Mailing Address - Country:US
Mailing Address - Phone:443-674-8226
Mailing Address - Fax:443-674-8346
Practice Address - Street 1:2316 PULASKI HWY STE A
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3730
Practice Address - Country:US
Practice Address - Phone:443-674-8226
Practice Address - Fax:443-674-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-03
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP068613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152233OtherPK