Provider Demographics
NPI:1700928116
Name:EAST SIDE PHARMACY, INC
Entity Type:Organization
Organization Name:EAST SIDE PHARMACY, INC
Other - Org Name:EASTVIEW PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:212-348-0406
Mailing Address - Street 1:1751 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5363
Mailing Address - Country:US
Mailing Address - Phone:212-348-0406
Mailing Address - Fax:212-348-5864
Practice Address - Street 1:1751 2ND AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5363
Practice Address - Country:US
Practice Address - Phone:212-348-0406
Practice Address - Fax:212-348-5864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty