Provider Demographics
NPI:1770626624
Name:EASTERN PHARMACEUTICALS
Entity type:Organization
Organization Name:EASTERN PHARMACEUTICALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:443-283-8400
Mailing Address - Street 1:5003 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3048
Mailing Address - Country:US
Mailing Address - Phone:443-283-8400
Mailing Address - Fax:443-893-7145
Practice Address - Street 1:5003 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3048
Practice Address - Country:US
Practice Address - Phone:443-283-8400
Practice Address - Fax:443-893-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP041953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD003621800Medicaid
2132277OtherNCPDP NUMBER
5538910001Medicare ID - Type UnspecifiedFEDERAL MEDICARE NUMBER