EASTBORN RX PHARMACY LLC (EASTBORN RX PHARMACY) - NPI NUMBER 1396091518

Summary

Provider Name: EASTBORN RX PHARMACY LLC (EASTBORN RX PHARMACY)

NPI Number: 1396091518

Clasification: Pharmacy (3336C0003X)

Specialization: Community/Retail Pharmacy

Address:
7526 WYOMING ST
SUITE 1
DEARBORN, MI
ZIP 48126

Phone Number: (313) 491-1010



Detailed Information

EASTBORN RX PHARMACY LLC is a community/retail pharmacy pharmacy in Dearborn, MI. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. The assigned NPI number for this provider is 1396091518 and is registered as an organization entity type.
The provider Is Doing Business As Eastborn Rx Pharmacy.

The provider's business address is:

7526 WYOMING ST
SUITE 1
DEARBORN, MI
ZIP 48126-690
Phone: (313) 491-1010
Fax: (313) 491-2020

The provider's authorized official is Ali Cheaito .
The authorized official title is Owner and has the following contact phone number (313) 491-1010.

The enumeration date for this NPI number is 7/25/2012 and was last updated on 12/21/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 3336C0003X Pharmacy Community/Retail Pharmacy 5301009915 MI Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 2377198 OTHER NCPDP PROVIDER IDENTIFICATION NUMBER

NPI Record

No. Field Name Field Value
1 NPI 1396091518
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name EASTBORN RX PHARMACY LLC
5 Provider Other Organization Name EASTBORN RX PHARMACY
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 7526 WYOMING ST
8 Provider Second Line Business Practice Location Address SUITE 1
9 Provider Business Practice Location Address City Name DEARBORN
10 Provider Business Practice Location Address State Name MI
11 Provider Business Practice Location Address Postal Code 481261690
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 3134911010
14 Provider Business Practice Location Address Fax Number 3134912020
15 Provider Enumeration Date 7/25/2012
16 Last Update Date 12/21/2012
17 Authorized Official Last Name CHEAITO
18 Authorized Official First Name ALI
19 Authorized Official Title or Position OWNER
20 Authorized Official Telephone Number 3134911010
21 Healthcare Provider Taxonomy Code 1 3336C0003X
22 Provider License Number 1 5301009915
23 Provider License Number State Code 1 MI
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 2377198
26 Other Provider Identifier Type Code 1 01
27 Other Provider Identifier Issuer 1 NCPDP PROVIDER IDENTIFICATION NUMBER
28 Is Organization Subpart N
29 Authorized Official Credential Text PHARM. D

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.