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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