Provider Demographics
NPI:1255904579
Name:EAST PINES PHARMACY LLC
Entity type:Organization
Organization Name:EAST PINES PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OMOTAYO
Authorized Official - Middle Name:S
Authorized Official - Last Name:AWOTUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:301-459-6211
Mailing Address - Street 1:6003 66TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1780
Mailing Address - Country:US
Mailing Address - Phone:301-459-6211
Mailing Address - Fax:301-459-6217
Practice Address - Street 1:6003 66TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1780
Practice Address - Country:US
Practice Address - Phone:301-459-6211
Practice Address - Fax:301-459-6217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAST PINES PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies