Healthcare Provider Details

I. General information

NPI: 1073873378
Provider Name (Legal Business Name): ESL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W COURT ST
PASCO WA
99301-4070
US

IV. Provider business mailing address

107 ERICA DR
RICHLAND WA
99352-8463
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-0953
  • 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

VIII. Authorized Official

Name: ESLAM MOHAMED
Title or Position: OFFICER/PHARMACIST
Credential:
Phone: 732-762-4960