| NPI | 1720212681 |
|---|---|
| Doing Business As | EASTSIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | SAM KHREIZAT Owner 313-579-1755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MI 5301009095) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| Enumeration Date | 2009-05-07 |
| Last Update Date | 2014-11-13 |