Provider Demographics
NPI:1508959941
Name:NORTH EAST DRUGS LLC
Entity Type:Organization
Organization Name:NORTH EAST DRUGS LLC
Other - Org Name:JAMES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KALIDINDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-665-8454
Mailing Address - Street 1:1119 LIGHT ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4104
Mailing Address - Country:US
Mailing Address - Phone:410-752-5810
Mailing Address - Fax:410-727-5403
Practice Address - Street 1:1119 LIGHT ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4104
Practice Address - Country:US
Practice Address - Phone:410-752-5810
Practice Address - Fax:410-727-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336L0003X
MDP072013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162484OtherPK
MD111592800Medicaid
MD486872200Medicaid