MEDICARE: ESL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4934635	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1073873378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESL LLC

Provider Business Mailing Address
First Line	:	107 ERICA DR
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-8463
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 W COURT ST
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-4070
Country	:	US
Telephone Number	:	509-547-0953
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/PHARMACIST
Name	:	ESLAM MOHAMED
Credential	:
Telephone Number	:	732-762-4960

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	05/24/2012

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Directions to “ESL LLC ” Practice Location

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