Healthcare Provider Details

I. General information

NPI: 1477852838
Provider Name (Legal Business Name): EST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S 10TH AVE
PASCO WA
99301-6806
US

IV. Provider business mailing address

107 ERICA DR
RICHLAND WA
99352-8463
US

V. Phone/Fax

Practice location:
  • Phone: 509-545-0596
  • Fax: 509-547-3355
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60219353
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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