MEDICARE: MR. DAVID S ELD RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	28RI01558700	NJ

General Provider Information

NPI Number	:	1164741955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID S ELD RPH

Provider Business Mailing Address
First Line	:	209 STAFFORD PARK BLVD
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2734
Country	:	US
Telephone Number	:	609-978-4923
Fax Number	:	609-978-4923

Provider Business Practice Location Address
First Line	:	209 STAFFORD PARK BLVD
Second Line	:
City	:	MANAHAWKIN
State	:	NJ
Zip	:	08050-2734
Country	:	US
Telephone Number	:	609-978-4923
Fax Number	:	609-978-4923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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