# EASTSIDE EXPRESS PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457402737
- **Authorized official:** MS. IRENE OVALLE MEDINA RPH (MANAGER)
- **Authorized official phone:** (719) 596-4650

## Contact information

- **Practice address:** 2141 ACADEMY CIR, COLORADO SPRINGS, CO 80909-1686
- **Practice address phone:** (719) 596-4650
- **Mailing address:** 2141 ACADEMY CIR, COLORADO SPRINGS, CO 80909-1686
- **Mailing address phone:** (719) 596-4650

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 183500000X | Pharmacist | 13573 | CO | Yes |

## Other

- **Enumeration date:** 01/15/2007
- **Last updated:** 07/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 03003704 | — | CO |
| 01 | — | 0615510 | NCPDP | CO |