Provider Demographics
NPI:1891969911
Name:EAST RIVER ASSOCIATES LLC
Entity Type:Organization
Organization Name:EAST RIVER ASSOCIATES LLC
Other - Org Name:SAV- MOR #100
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-558-1567
Mailing Address - Street 1:13101 ALLEN ROAD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195
Mailing Address - Country:US
Mailing Address - Phone:734-374-2335
Mailing Address - Fax:734-374-2339
Practice Address - Street 1:13101 ALLEN ROAD
Practice Address - Street 2:SUITE 511
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195
Practice Address - Country:US
Practice Address - Phone:734-374-2335
Practice Address - Fax:734-374-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301008855333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2371069OtherOTHER ID NUMBER
MI2371069Medicaid