Provider Demographics
NPI:1659822518
Name:EASTON SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:EASTON SPECIALTY PHARMACY INC
Other - Org Name:EASTON SPECIALTY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-600-6666
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:TREXLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18087-0855
Mailing Address - Country:US
Mailing Address - Phone:484-600-6666
Mailing Address - Fax:484-600-6565
Practice Address - Street 1:2024 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3817
Practice Address - Country:US
Practice Address - Phone:484-600-6666
Practice Address - Fax:484-600-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP4826833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2164685OtherPK
PA1032198880001Medicaid