Healthcare Provider Details

I. General information

NPI: 1528457728
Provider Name (Legal Business Name): ESTM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N ELY ST STE C1
KENNEWICK WA
99336-2941
US

IV. Provider business mailing address

107 ERICA DR
RICHLAND WA
99352-8463
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-0596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESLAM MOHAMED
Title or Position: OFFICER
Credential:
Phone: 509-545-0596