Provider Demographics
NPI:1518268408
Name:ESTENAJ LLC
Entity Type:Organization
Organization Name:ESTENAJ LLC
Other - Org Name:PROHEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBADE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-488-5091
Mailing Address - Street 1:4532 ERDMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2606
Mailing Address - Country:US
Mailing Address - Phone:410-488-5091
Mailing Address - Fax:866-528-5343
Practice Address - Street 1:4532 ERDMAN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-2606
Practice Address - Country:US
Practice Address - Phone:410-488-5091
Practice Address - Fax:866-528-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16250333600000X, 3336C0003X, 3336C0004X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy