MEDICARE: ESTENAJ LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	16250	MD
2	3336C0004X	Compounding Pharmacy	16250	MD
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	16250	MD

General Provider Information

NPI Number	:	1518268408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTENAJ LLC

Provider Business Mailing Address
First Line	:	4532 ERDMAN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-2606
Country	:	US
Telephone Number	:	410-488-5091
Fax Number	:	866-528-5343

Provider Business Practice Location Address
First Line	:	4532 ERDMAN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-2606
Country	:	US
Telephone Number	:	410-488-5091
Fax Number	:	866-528-5343

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	BUKOLA AJIBADE
Credential	:	RPH
Telephone Number	:	410-488-5091

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	03/15/2022

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Directions to “ESTENAJ LLC ” Practice Location

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