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General NPI Number Information
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NPI Number | 1891969911
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Entity Type | Organization
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Legal Business Name | EAST RIVER ASSOCIATES LLC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 13101 ALLEN ROAD SUITE 511
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City | SOUTHGATE
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State | MI
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Zip | 48195
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Country | US
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Telephone | 734-374-2335
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Fax | 734-374-2339
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Provider Business Mailing Address
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Address Line | 13101 ALLEN ROAD SUITE 511
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City | SOUTHGATE
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State | MI
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Zip | 48195
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Country | US
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Telephone | 734-374-2335
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Fax | 734-374-2339
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES W HASTINGS
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Credential | RPH
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Telephone | 734-558-1567
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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 | 5301008855
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License Number State | MI
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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 | 5301008855
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License Number State | MI
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