Provider Demographics
NPI:1548584634
Name:EASTSIDE PHARMACY INC
Entity Type:Organization
Organization Name:EASTSIDE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:ALAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-386-5066
Mailing Address - Street 1:9711 SHADOW VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5381
Mailing Address - Country:US
Mailing Address - Phone:423-386-5066
Mailing Address - Fax:423-443-4297
Practice Address - Street 1:6857 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6406
Practice Address - Country:US
Practice Address - Phone:423-386-5066
Practice Address - Fax:423-386-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy