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NPI Code Detail

MEDICARE: CREATIVE PHARMACY SOLUTIONS EAST LLC

MEDICARE: CREATIVE PHARMACY SOLUTIONS EAST 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
13336C0003XCommunity/Retail Pharmacy
23336C0004XCompounding Pharmacy
33336M0002XMail Order Pharmacy
4333600000XPharmacy0201003136VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22154895OTHERPK

General Provider Information

NPI Number : 1700894649
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATIVE PHARMACY SOLUTIONS EAST LLC
Provider Business Mailing Address
First Line : 2535 JOHNS PL
Second Line :
City : JAMESTOWN
State : NY
Zip : 14701-9210
Country : US
Telephone Number : 716-720-5121
Fax Number : 716-708-6248
Provider Business Practice Location Address
First Line : 4001 VIRGINIA BEACH BLVD STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-1759
Country : US
Telephone Number : 757-934-0533
Fax Number : 757-228-3991
Authorized Official
Title or Position : OWNER
Name : RICHARD MOON
Credential :
Telephone Number : 716-720-5121
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/13/2022

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Directions to “CREATIVE PHARMACY SOLUTIONS EAST LLC ” Practice Location

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