Healthcare Provider Details

I. General information

NPI: 1831407113
Provider Name (Legal Business Name): NORTHEAST PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 HOSPITAL ST
GREENVILLE MS
38703-3225
US

IV. Provider business mailing address

3480 EASTERN BLVD
MONTGOMERY AL
36116-1700
US

V. Phone/Fax

Practice location:
  • Phone: 334-356-7627
  • Fax: 334-356-8347
Mailing address:
  • Phone: 334-819-4500
  • Fax: 334-356-8347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number08654
License Number StateMS

VIII. Authorized Official

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