Provider Demographics
NPI:1881137875
Name:EASTERN PHARMACY INC
Entity type:Organization
Organization Name:EASTERN PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHBUB
Authorized Official - Middle Name:ZAMAN
Authorized Official - Last Name:KHUNDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-252-3357
Mailing Address - Street 1:15913 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3935
Mailing Address - Country:US
Mailing Address - Phone:917-396-4944
Mailing Address - Fax:917-396-4926
Practice Address - Street 1:15913 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3935
Practice Address - Country:US
Practice Address - Phone:917-396-4944
Practice Address - Fax:917-396-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035006333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04731297Medicaid