Healthcare Provider Details

I. General information

NPI: 1558290312
Provider Name (Legal Business Name): EASTSIDE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PINE ST
POPLAR BLUFF MO
63901-5401
US

IV. Provider business mailing address

400 E PINE ST
POPLAR BLUFF MO
63901-5401
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-7238
  • Fax: 573-686-7239
Mailing address:
  • Phone: 573-686-7238
  • Fax: 573-686-7239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEPHEN K ROWLAND
Title or Position: OWNER
Credential: PIC, RPH
Phone: 573-686-7238