Organization
EASTSIDE PHARMACY INC
Active
Organization
EASTSIDE PHARMACY INC
Active
Other names
EASTSIDE SAVMOR PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN GRAHAM (MGR PHARMACY SERVICES)
(248) 348-1570
Entity
Organization
Contact information
Practice address
11937 E WARREN AVE, DETROIT, MI 48214-1665
(313) 579-1755
(313) 579-2067
Mailing address
43155 W 9 MILE RD, NOVI, MI 48375-4190
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301007485
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2363428
OTHER ID NUMBER
—
05
—
2363428
—
MI
Enumeration date
08/27/2006
Last updated
04/15/2008
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