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General NPI Number Information
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NPI Number | 1841674538
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Entity Type | Organization
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Legal Business Name | EASTSIDE PHARMACY, INC.
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Dates
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Enumeration Date | 07/13/2015
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 400 E PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901
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Country | US
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Telephone | 573-686-7238
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Fax | 573-686-7239
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Provider Business Mailing Address
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Address Line | 400 E PINE ST
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-5401
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Country | US
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Telephone | 573-686-7238
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Fax | 573-686-7239
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | STEPHEN KENNEDY ROWLAND
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Credential | RPH
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Telephone | 573-686-7238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 005573
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License Number State | MO
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