Organization
EST LLC
Active
Organization
EST LLC
Active
Other names
Fiesta Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ESLAM MOHAMED RPH (PHARMACIST / OWNER)
(732) 762-4960
Entity
Organization
Contact information
Practice address
115 S 10TH AVE, PASCO, WA 99301-6806
(509) 545-0596
(509) 547-3355
Mailing address
107 ERICA DR, RICHLAND, WA 99352-8463
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60219353
WA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2044998
—
WA
01
—
2129654
PK
—
Enumeration date
03/23/2011
Last updated
08/10/2016
Update your record
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