Provider Demographics
NPI:1225166762
Name:EAST END PHARMACY INC
Entity Type:Organization
Organization Name:EAST END PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-888-2830
Mailing Address - Street 1:20381 ARCH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-9218
Mailing Address - Country:US
Mailing Address - Phone:501-888-2830
Mailing Address - Fax:501-888-3118
Practice Address - Street 1:20381 ARCH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-9218
Practice Address - Country:US
Practice Address - Phone:501-888-2830
Practice Address - Fax:501-888-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1074600001Medicare ID - Type Unspecified