Healthcare Provider Details

I. General information

NPI: 1912340639
Provider Name (Legal Business Name): NORTHEAST PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 UPPER WETUMPKA RD
MONTGOMERY AL
36107-1342
US

IV. Provider business mailing address

3480 EASTERN BLVD
MONTGOMERY AL
36116-1700
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-7627
  • Fax: 334-356-7647
Mailing address:
  • Phone: 334-356-7627
  • Fax: 334-356-7647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number114090
License Number StateAL

VIII. Authorized Official

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