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Organization
NORTHEAST PHARMACEUTICALS, INC.
Active
Organization
NORTHEAST PHARMACEUTICALS, INC.
Active
Other names
Northeast Pharmaceuticals, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL MIMS (DIRECTOR OF OPERATIONS)
(334) 356-7627
Entity
Organization
Contact information
Practice address
6 MATHIS DR NW, ROME, GA 30165-1242
(706) 237-6306
(706) 622-2135
Mailing address
3480 EASTERN BLVD, MONTGOMERY, AL 36116-1700
(334) 356-7627
(334) 356-8347
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHRE009839
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1162611
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/09/2012
Last updated
06/05/2014
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