Provider Demographics
NPI:1073873378
Name:ESL LLC
Entity Type:Organization
Organization Name:ESL LLC
Other - Org Name:COLUMBIA MEDICAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ESLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-762-4960
Mailing Address - Street 1:107 ERICA DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1525 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4070
Practice Address - Country:US
Practice Address - Phone:509-547-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4934635OtherNCPDP PROVIDER IDENTIFICATION NUMBER