Provider Demographics
NPI:1013011071
Name:ESTERBROOK WRD PHARMACY LLC
Entity Type:Organization
Organization Name:ESTERBROOK WRD PHARMACY LLC
Other - Org Name:WEST READING DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-269-7751
Mailing Address - Street 1:538 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1036
Mailing Address - Country:US
Mailing Address - Phone:610-375-4366
Mailing Address - Fax:610-372-7710
Practice Address - Street 1:538 PENN AVE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1036
Practice Address - Country:US
Practice Address - Phone:610-375-4366
Practice Address - Fax:610-372-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412856L3336C0003X, 3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103138879Medicaid
2164002OtherPK