Organization
EASTLAKE PHARMACY INC
Active
Other names
EASTLAKE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS JUSU (OWNER PHARMACIST-IN-CHARGE)
(678) 357-1044
Entity
Organization
Contact information
Practice address
1308 GLENWOOD AVE SE, ATLANTA, GA 30316-2077
(770) 593-8688
Mailing address
4141 BROOKS MILL DR, LITHONIA, GA 30038-4144
(678) 357-1044
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009881
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163029
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/30/2012
Last updated
11/30/2012
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up