Healthcare Provider Details

I. General information

NPI: 1013011071
Provider Name (Legal Business Name): ESTERBROOK WRD PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 PENN AVE
WEST READING PA
19611-1036
US

IV. Provider business mailing address

538 PENN AVE
WEST READING PA
19611-1036
US

V. Phone/Fax

Practice location:
  • Phone: 610-375-4366
  • Fax: 610-372-7710
Mailing address:
  • Phone: 610-375-4366
  • Fax: 610-372-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP412856L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC ESTERBROOK
Title or Position: MANAGER/MEMBER
Credential:
Phone: 484-269-7751