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General NPI Number Information
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NPI Number | 1093722134
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Entity Type | Organization
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Legal Business Name | EAST SHORE PHARMACY INC.
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 2723 AGATE ST
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City | HARRISBURG
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State | PA
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Zip | 17110-2645
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Country | US
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Telephone | 717-213-3708
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Fax | 717-213-0095
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Provider Business Mailing Address
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Address Line | 2723 AGATE ST
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City | HARRISBURG
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State | PA
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Zip | 17110-2645
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Country | US
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Telephone | 717-213-3708
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Fax | 717-213-0956
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW MUBBALA
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Credential | RPH
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Telephone | 717-213-3708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PP481584
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License Number State | PA
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