NPIMap

Organization Active NPI

Eastside Pharmacy, Inc.

Doing business as East Side Pharmacy

  • Community/Retail Pharmacy
  • Poplar Bluff, MO
National Provider Identifier
1841674538
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
005573 Issued in MO
Legal business name
EASTSIDE PHARMACY, INC.
Doing business as
East Side Pharmacy
Practice address
400 E Pine St
Poplar Bluff, MO 63901
Phone
(573) 686-7238
Fax
(573) 686-7239
NPI assigned
Jul 13, 2015
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Stephen Kennedy Rowland, RPHNPI 1639853278
Title
Pharmacist/Owner
Phone
(573) 686-7238

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 005573 MO Primary

Addresses

Primary practice location

400 E Pine St
Poplar Bluff, MO 63901

Mailing address

400 E Pine St
Poplar Bluff, MO 63901-5401
Phone (573) 686-7238

Other identifiers 1

IdentifierTypeStateIssuer
601773500MedicaidMO

Other names 1

  • East Side Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
East Side Pharmacy5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1841674538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E PINE ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015401",
            "telephone_number": "573-686-7238",
            "fax_number": "573-686-7239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E PINE ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-686-7238",
            "fax_number": "573-686-7239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-13",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "ROWLAND",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "KENNEDY",
        "authorized_official_title_or_position": "PHARMACIST/OWNER",
        "authorized_official_telephone_number": "573-686-7238",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "005573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601773500",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Side Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.