Provider Demographics
NPI:1144631102
Name:EAST BROWN STREET PHARMACY, INC
Entity type:Organization
Organization Name:EAST BROWN STREET PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RIYADH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-872-9800
Mailing Address - Street 1:364 N COURTLAND ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1930
Mailing Address - Country:US
Mailing Address - Phone:570-369-5833
Mailing Address - Fax:570-872-9888
Practice Address - Street 1:364 N COURTLAND ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1930
Practice Address - Country:US
Practice Address - Phone:570-369-5833
Practice Address - Fax:570-872-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP482449333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy