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General NPI Number Information
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NPI Number | 1053679860
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Entity Type | Organization
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Legal Business Name | ESB INVESTMENTS LLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 181 HIGHWAY 84 W
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City | DALEVILLE
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State | AL
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Zip | 36322-9113
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Country | US
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Telephone | 334-598-4242
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Fax | 334-598-4240
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Provider Business Mailing Address
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Address Line | 181 HIGHWAY 84 W
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City | DALEVILLE
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State | AL
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Zip | 36322-9113
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Country | US
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Telephone | 334-598-4242
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Fax | 334-598-4240
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Authorized Official
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Title or Position | OWNER/PRESIDENT/PHARMACIST
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Name | STACY BOUCHER
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Credential |
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Telephone | 334-763-0146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 113893
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License Number State | AL
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