Provider Demographics
NPI:1932957297
Name:NORTHEASTERN PHARMACY LLC
Entity Type:Organization
Organization Name:NORTHEASTERN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHMOND
Authorized Official - Suffix:
Authorized Official - Credentials:REG PHARMACIST
Authorized Official - Phone:954-237-9841
Mailing Address - Street 1:321 NE 90TH ST
Mailing Address - Street 2:
Mailing Address - City:EL PORTAL
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3125
Mailing Address - Country:US
Mailing Address - Phone:954-237-9841
Mailing Address - Fax:786-963-6209
Practice Address - Street 1:10645 NW 7TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-1067
Practice Address - Country:US
Practice Address - Phone:786-963-6008
Practice Address - Fax:786-963-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy