Healthcare Provider Details

I. General information

NPI: 1083629125
Provider Name (Legal Business Name): ESTERBROOK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE STE 145
WEST READING PA
19611-1410
US

IV. Provider business mailing address

301 S 7TH AVE STE 145
WEST READING PA
19611-1410
US

V. Phone/Fax

Practice location:
  • Phone: 610-376-6542
  • Fax: 610-376-4177
Mailing address:
  • Phone: 610-376-6542
  • Fax: 610-376-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPP413225L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIC ESTERBROOK
Title or Position: PHCST
Credential: RPH
Phone: 610-376-6542