Provider Demographics
NPI:1386661130
Name:ESENBEE, INC
Entity Type:Organization
Organization Name:ESENBEE, INC
Other - Org Name:BOLTON HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:YELLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:225-343-4869
Mailing Address - Street 1:2958 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-2248
Mailing Address - Country:US
Mailing Address - Phone:225-343-4869
Mailing Address - Fax:225-343-4819
Practice Address - Street 1:2958 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-2248
Practice Address - Country:US
Practice Address - Phone:225-343-4869
Practice Address - Fax:225-343-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1261025Medicaid
LA1261025Medicaid