Provider Demographics
NPI:1053679860
Name:ESB INVESTMENTS LLC
Entity Type:Organization
Organization Name:ESB INVESTMENTS LLC
Other - Org Name:CENTER DRUGS OF DALEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-763-0146
Mailing Address - Street 1:181 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36322-9113
Mailing Address - Country:US
Mailing Address - Phone:334-598-4242
Mailing Address - Fax:334-598-4240
Practice Address - Street 1:181 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36322-9113
Practice Address - Country:US
Practice Address - Phone:334-598-4242
Practice Address - Fax:334-598-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X, 3336S0011X
AL1138933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134906OtherPK
AL137765Medicaid