# NORTHEAST PHARMACEUTICALS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northeast Pharmaceuticals, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821353657
- **Authorized official:** KRYSTAL MIMS (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (334) 356-7627

## Contact information

- **Practice address:** 6 MATHIS DR NW, ROME, GA 30165-1242
- **Practice address phone:** (706) 237-6306
- **Practice address fax:** (706) 622-2135
- **Mailing address:** 3480 EASTERN BLVD, MONTGOMERY, AL 36116-1700
- **Mailing address phone:** (334) 356-7627
- **Mailing address fax:** (334) 356-8347

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PHRE009839 | GA | Yes |

## Other

- **Enumeration date:** 07/09/2012
- **Last updated:** 06/05/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1162611 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |