Organization
EASTSIDE PHARMACY AND CUSTOM COMPOUNDING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE D. CANNON PHARMD (PRESIDENT)
(256) 233-7070
Entity
Organization
Contact information
Practice address
1406 LINDSAY LANE SOUTH, SUITE A, ATHENS, AL 35613
(256) 233-7070
(256) 233-8891
Mailing address
1406 LINDSAY LANE SOUTH, SUITE A, ATHENS, AL 35613
(256) 233-7070
(256) 233-8891
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
112977
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100039186
—
AL
Enumeration date
08/01/2007
Last updated
03/23/2021
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