Healthcare Provider Details

I. General information

NPI: 1164753596
Provider Name (Legal Business Name): NATALYA S ELEVICH PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 E MAIN ST
MESA AZ
85205-7902
US

IV. Provider business mailing address

1935 N STAPLEY DR
MESA AZ
85203-2749
US

V. Phone/Fax

Practice location:
  • Phone: 480-228-8573
  • Fax:
Mailing address:
  • Phone: 480-610-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS017544
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: