Provider Demographics
NPI:1437505880
Name:PHYSICIANS EAST PA
Entity type:Organization
Organization Name:PHYSICIANS EAST PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-795-8800
Mailing Address - Street 1:PO BOX 3488 DEPT #05-800
Mailing Address - Street 2:C/O PHARMAPOINT
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803
Mailing Address - Country:US
Mailing Address - Phone:205-795-8800
Mailing Address - Fax:205-795-8880
Practice Address - Street 1:1850 W ARLINGTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5704
Practice Address - Country:US
Practice Address - Phone:252-413-6208
Practice Address - Fax:252-413-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC129463336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159700OtherPK