Provider Demographics
NPI:1285683094
Name:EASTERN PHARMACY INC
Entity Type:Organization
Organization Name:EASTERN PHARMACY INC
Other - Org Name:SAV-MOR#65 EASTERN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DABAJA
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:313-999-5720
Mailing Address - Street 1:1159 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5807
Mailing Address - Country:US
Mailing Address - Phone:734-485-9900
Mailing Address - Fax:734-485-9300
Practice Address - Street 1:1159 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5807
Practice Address - Country:US
Practice Address - Phone:734-485-9900
Practice Address - Fax:734-485-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010083363336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2368252OtherNCPDP PROVIDER IDENTIFICATION NUMBER