MEDICARE: EST 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	3336L0003X	Long Term Care Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHAR.CF.60219353	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2129654	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477852838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EST 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	:	115 S 10TH AVE
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-6806
Country	:	US
Telephone Number	:	509-545-0596
Fax Number	:	509-547-3355

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	08/10/2016

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Directions to “EST LLC ” Practice Location

Language	Start Address	Practice Location

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