EASTSIDE PHARMACY INC (NPI# 1720212681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720212681 |
| Entity Type | Organization |
| Organization Name | EASTSIDE PHARMACY INC |
| Other Organization Name | EASTSIDE PHARMACY |
| Practice Address |
11854 E Warren Ave Detroit MI 48214-1664 |
| Practice Telephone | 3135791755 |
| Practice Fax Number | 3135792067 |
| Mailing Telephone | 3135791755 |
| Mailing Fax Number | 3135792067 |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2014-11-13 |
| Authorized Official Name | SAM KHREIZAT (OWNER) |
| Authorized Official Telephone | 3135791755 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
5301009095 | MI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2120128 | 01 |
| Other Name | Type Code |
|---|---|
| Eastside Pharmacy | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548584634 | Eastside Pharmacy Inc | Pharmacy | 6857 Lee Hwy, Chattanooga, TN 37421-6406 | 2010-03-18 |
| 1336257708 | Eastside Pharmacy Inc | Pharmacy | 11937 E Warren Ave, Detroit, MI 48214-1665 | 2006-08-27 |
| 1841674538 | Eastside Pharmacy Inc | Pharmacy | 400 E Pine St, Poplar Bluff, MO 63901 | 2015-07-13 |
| Street Address |
11854 E WARREN AVE |
| City | DETROIT |
| State | MI |
| Zip Code | 48214-1664 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376042325 | Tamara Wesley | Registered Nurse | 9000 E. Jefferson Apt 28-14, Detroit, MI 48214 | 2018-02-06 |
| 1720534381 | Birth Beautiful Detroit | Clinic/Center | 1086 Baldwin, Detroit, MI 48214 | 2016-09-01 |
| 1225402886 | Steven Doyle Whatley I | Counselor | 1423 Field Ave., Adult Well Being Services, Detroit, MI 48214 | 2015-11-19 |
| 1255587945 | Andrew Avery | Internal Medicine | 7733 East Jefferson Ave, Detroit, MI 48214 | 2008-08-13 |
| 1639330210 | Nicole Lashawn Greene | Specialist | 4533 St Clair St, Detroit, MI 48214 | 2008-06-17 |
| 1629299433 | Alan R Faber Jr. | Dentist | 8191 E Jefferson Ave, Detroit, MI 48214 | 2007-05-01 |
| 1518188598 | Mary F Bridges | Psychiatry & Neurology | 8120 East Jefferson #3l, Detroit, MI 48214 | 2007-05-01 |
| 1053439737 | Geraldine Etella Davis | Counselor | 3840 Fairview St., Detroit, MI 48214 | 2007-03-27 |
| 1639203482 | Detroit-macomb Hospital Corporation | Advanced Practice Midwife | 7815 E. Jefferson, Detroit, MI 48214 | 2007-03-15 |
| 1033275441 | Anesha Amor Rouse | Physical Therapy Assistant | 7633 E. Jefferson Ave, Suite 170, Detroit, MI 48214 | 2006-12-29 |
| Find all providers in zip 48214 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1912523986 | Gratiot Seven Pharmacy, LLC | Pharmacy | 12740 Gratiot Ave Ste 100, Detroit, MI 48205-3944 | 2020-06-24 |
| 1396361366 | Grand Greenfield Pharmacy, LLC | Pharmacy | 14661 Greenfield Rd Ste B, Detroit, MI 48227-2231 | 2020-06-24 |
| 1114556859 | Buena Salud LLC | Pharmacy | 7607 W Vernor Hwy, Detroit, MI 48209-1513 | 2020-04-04 |
| 1932737210 | West Park Pharmacy LLC | Pharmacy | 16240 W Warren Ave, Detroit, MI 48228 | 2020-03-31 |
| 1952938516 | Sinai Medical Pharmacy, LLC | Pharmacy | 16841 Schaefer Hwy, Detroit, MI 48235-4271 | 2020-03-24 |
| 1881231991 | Six Mile Medical Pharmacy, LLC | Pharmacy | 10420 W Mcnichols Rd Ste A, Detroit, MI 48221-2356 | 2019-12-08 |
| 1215570791 | Goshen Pharmacy LLC | Pharmacy | 16800 Greenfield Rd Unit B2, Detroit, MI 48235-3703 | 2019-10-28 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.