MEDICARE: EASTERN PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	3336C0003X	Community/Retail Pharmacy	5301008336	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2368252	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1285683094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN PHARMACY INC

Provider Business Mailing Address
First Line	:	1159 E MICHIGAN AVE
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-5807
Country	:	US
Telephone Number	:	734-485-9900
Fax Number	:	734-485-9300

Provider Business Practice Location Address
First Line	:	1159 E MICHIGAN AVE
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48198-5807
Country	:	US
Telephone Number	:	734-485-9900
Fax Number	:	734-485-9300

Authorized Official
Title or Position	:	RPH/PRESIDENT
Name	:	SAMI DABAJA
Credential	:	BS PHARMACY
Telephone Number	:	313-999-5720

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	06/23/2020

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Directions to “EASTERN PHARMACY INC ” Practice Location

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