Provider Demographics
NPI:1700412988
Name:ESTHERVILLE PHARMACY, L.L.C.
Entity Type:Organization
Organization Name:ESTHERVILLE PHARMACY, L.L.C.
Other - Org Name:ESTHERVILLE PHARMACY (LTC)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:402-650-6014
Mailing Address - Street 1:1804 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2465
Mailing Address - Country:US
Mailing Address - Phone:402-650-6014
Mailing Address - Fax:
Practice Address - Street 1:1804 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2465
Practice Address - Country:US
Practice Address - Phone:402-650-6014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy