Eastlake Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009881 Issued in GA

Legal business name

EASTLAKE PHARMACY INC

Doing business as

Eastlake Pharmacy

Practice address

1308 Glenwood Ave SE
Atlanta, GA 30316-2077

Phone

(770) 593-8688

NPI assigned

Nov 30, 2012

Last updated

Nov 30, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas JusuNPI 1912475559

Title

Owner Pharmacist-in-Charge

Phone

(678) 357-1044

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• EASTLAKE PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Sao Jusu, RPH

  • Pharmacist
  • Atlanta, GA
  • NPI 1912475559
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354233600000",
    "number": "1255676326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 BROOKS MILL DR",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300384144",
            "telephone_number": "678-357-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 GLENWOOD AVE SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303162077",
            "telephone_number": "770-593-8688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-30",
        "last_updated": "2012-11-30",
        "status": "A",
        "authorized_official_last_name": "JUSU",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER PHARMACIST-IN-CHARGE",
        "authorized_official_telephone_number": "678-357-1044"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE009881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1163029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTLAKE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kathryn E Easton, PHARMD
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• Community/Retail Pharmacy in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.