Organization
EASTSIDE PHARMACY, INC.
Active
Other names
East Side Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN KENNEDY ROWLAND RPH (PHARMACIST/OWNER)
(573) 686-7238
Entity
Organization
Contact information
Practice address
400 E PINE ST, POPLAR BLUFF, MO 63901-5401
(573) 686-7238
(573) 686-7239
Mailing address
400 E PINE ST, POPLAR BLUFF, MO 63901-5401
(573) 686-7238
(573) 686-7239
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
621773506
MO
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5573
MO
3336L0003X
Long Term Care Pharmacy
5573
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2619623
NABP #
—
05
—
601773500
—
MO
05
—
621773506
—
MO
Enumeration date
05/20/2006
Last updated
03/26/2024
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