NPIMap

Organization Active NPI

East Pines Pharmacy LLC

  • Community/Retail Pharmacy
  • Riverdale, MD
National Provider Identifier
1386893642
Registry record updated Mar 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
P04821 Issued in MD
Legal business name
EAST PINES PHARMACY LLC
Practice address
6003 66TH Ave
Riverdale, MD 20737-1780
Phone
(301) 459-6211
Fax
(301) 459-6217
NPI assigned
Sep 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2013

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

Authorized official

Name
Omotayo AwotundeNPI 1275643496
Title
President
Phone
(301) 459-6211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X P04821 MD Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

6003 66TH Ave
Riverdale, MD 20737-1780

Mailing address

6003 66TH Ave
Riverdale, MD 20737-1780
Phone (301) 459-6211

Other identifiers 2

IdentifierTypeStateIssuer
440047000MedicaidMD
2134245OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • East Pines Pharmacy LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100930059134 MD DME Supplier - PharmacyDME Supplier - Orthotic Personnel 0244430445 Practice locations: Riverdale, MD
O20210603002518 DC Part B Supplier - Pharmacy 0244430445 Practice locations: Riverdale, MD
O20250306001715 DC Part B Supplier - Independent Clinical Laboratory 0244430445 Practice locations: Riverdale, MD

National Provider Directory

National Provider Directory
Tax ID family
East Pines Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6003 66th Ave
Riverdale, MD 20737
Phone (301) 459-6211

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1221091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362873600000",
    "number": "1386893642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6003 66TH AVE",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371780",
            "telephone_number": "301-459-6211",
            "fax_number": "301-459-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6003 66TH AVE",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371780",
            "telephone_number": "301-459-6211",
            "fax_number": "301-459-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST PINES PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-11",
        "last_updated": "2013-03-10",
        "status": "A",
        "authorized_official_last_name": "AWOTUNDE",
        "authorized_official_first_name": "OMOTAYO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-459-6211"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MD",
            "license": "P04821",
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "440047000",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2134245",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Pines Pharmacy LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.