Healthcare Provider Details

I. General information

NPI: 1245616127
Provider Name (Legal Business Name): ELANE ENDECOTT PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 E WASHINGTON ST
PHOENIX AZ
85034-2140
US

IV. Provider business mailing address

10 W MINNEZONA AVE APT 1091
PHOENIX AZ
85013-4929
US

V. Phone/Fax

Practice location:
  • Phone: 602-732-3384
  • Fax:
Mailing address:
  • Phone: 660-254-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS021412
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: