Eastside Express Pharmacy

Primary specialty

PharmacistTaxonomy code 183500000X

License

13573 Issued in CO

Legal business name

EASTSIDE EXPRESS PHARMACY

Practice address

2141 Academy Cir
Colorado Springs, CO 80909-1686

Phone

(719) 596-4650

NPI assigned

Jan 15, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Irene Ovalle Medina, RPH

Title

Manager

Phone

(719) 596-4650

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1457402737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2141 ACADEMY CIR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091686",
            "telephone_number": "719-596-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 ACADEMY CIR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091686",
            "telephone_number": "719-596-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE EXPRESS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "MEDINA",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "OVALLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "719-596-4650",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "13573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0615510",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03003704",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christian Eastlake
• Christopher W Eastman
• Sarah Eastman
• Natasha Eastmond
• Michelle Elizabeth Easton, FNP-C
• Ashley Michelle Eaton, FNP-C
• Kennedy Eaton, RBT
• Maureen Eaton
• Tara Noelle Eaton, LSW
• Jessica Eavenson

• Pharmacist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Pharmacist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.