Provider Demographics
NPI:1083629125
Name:ESTERBROOK PHARMACY LLC
Entity Type:Organization
Organization Name:ESTERBROOK PHARMACY LLC
Other - Org Name:ESTERBROOK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHCST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTERBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-376-6542
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:STE 145
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-376-6542
Mailing Address - Fax:610-376-4177
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:STE 145
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-376-6542
Practice Address - Fax:610-376-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413225L3336C0003X
3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5915870001Medicare NSC