Provider Demographics
NPI:1356009278
Name:EASTERN STATES COMPOUNDING PHARMACY, LLC
Entity Type:Organization
Organization Name:EASTERN STATES COMPOUNDING PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-444-0094
Mailing Address - Street 1:338 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-5616
Mailing Address - Country:US
Mailing Address - Phone:603-444-0094
Mailing Address - Fax:
Practice Address - Street 1:338 UNION ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-5616
Practice Address - Country:US
Practice Address - Phone:603-444-0094
Practice Address - Fax:603-444-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy