Healthcare Provider Details

I. General information

NPI: 1447496849
Provider Name (Legal Business Name): NORTHEAST PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3456 HILLCREST RD BLDG B STE D
MOBILE AL
36695-3195
US

IV. Provider business mailing address

3480 EASTERN BLVD
MONTGOMERY AL
36116-1700
US

V. Phone/Fax

Practice location:
  • Phone: 251-665-4521
  • Fax: 251-665-4522
Mailing address:
  • Phone: 334-356-7627
  • Fax: 334-356-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number113227
License Number StateAL

VIII. Authorized Official

Name: LATONYA PORTER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 334-356-7627