Healthcare Provider Details

I. General information

NPI: 1689671091
Provider Name (Legal Business Name): ERIC ESTERBROOK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 PENN AVE
WEST LAWN PA
19609-1436
US

IV. Provider business mailing address

532 S PARK RD
WYOMISSING PA
19610-2276
US

V. Phone/Fax

Practice location:
  • Phone: 610-678-1119
  • Fax:
Mailing address:
  • Phone: 610-373-1551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP044249L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: