Organization
EAST PINES PHARMACY LLC
Active
Other names
East Pines Pharmacy LLC
Organization subpart
No
Provider details
NPI number
Authorized official
OMOTAYO AWOTUNDE (PRESIDENT)
(301) 459-6211
Entity
Organization
Contact information
Practice address
6003 66TH AVE, RIVERDALE, MD 20737-1780
(301) 459-6211
(301) 459-6217
Mailing address
6003 66TH AVE, RIVERDALE, MD 20737-1780
(301) 459-6211
(301) 459-6217
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
P04821
MD
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2134245
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
440047000
—
MD
Enumeration date
09/11/2008
Last updated
03/10/2013
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