Healthcare Provider Details

I. General information

NPI: 1588152995
Provider Name (Legal Business Name): EAST GOSHEN PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SHORE RD
SOMERS POINT NJ
08244-2631
US

IV. Provider business mailing address

4222 PAYSPHERE CIRCLE
CHICAGO IL
60674-0042
US

V. Phone/Fax

Practice location:
  • Phone: 609-926-6577
  • Fax:
Mailing address:
  • Phone: 800-879-6137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SHAPIRO
Title or Position: PRESIDENT & CFO
Credential:
Phone: 800-879-6137