MEDICARE: EAST GOSHEN PHARMACY, LLC

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	3336C0004X	Compounding Pharmacy
2	261QI0500X	Infusion Therapy Clinic/Center
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	PP413617L	PA
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	3336S0011X	Specialty Pharmacy
6	251F00000X	Home Infusion Agency
7	3336M0002X	Mail Order Pharmacy
8	333600000X	Pharmacy	PP413617L	PA
9	3336H0001X	Home Infusion Therapy Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PP413617L	OTHER	PA	LICENSE
2	A9-0000919	OTHER	DE	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	28RO00043200	OTHER	NJ	LICENSE
6	NRX1000210	OTHER	DC	LICENSE

General Provider Information

NPI Number	:	1679531693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST GOSHEN PHARMACY, LLC

Provider Business Mailing Address
First Line	:	4222 PAYSPHERE CIRCLE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0042
Country	:	US
Telephone Number	:	800-879-6137
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 RITTENHOUSE RD STE 200
Second Line	:
City	:	AUDUBON
State	:	PA
Zip	:	19403-2265
Country	:	US
Telephone Number	:	610-344-0450
Fax Number	:	610-431-1931

Authorized Official
Title or Position	:	PRESIDENT & CFO
Name	:	MEENAL SETHNA
Credential	:
Telephone Number	:	800-879-6137

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	10/14/2025

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