MEDICARE: NORTHEAST PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy

General Provider Information

NPI Number	:	1548499643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST PHARMACY INC

Provider Business Mailing Address
First Line	:	4576 MORSE CENTRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6602
Country	:	US
Telephone Number	:	614-344-4111
Fax Number	:	614-467-2009

Provider Business Practice Location Address
First Line	:	4576 MORSE CENTRE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-6602
Country	:	US
Telephone Number	:	614-344-4111
Fax Number	:	614-467-2009

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	UREJI AHMED
Credential	:
Telephone Number	:	614-344-4111

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	03/08/2012

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