Healthcare Provider Details

I. General information

NPI: 1144632563
Provider Name (Legal Business Name): SRI SARAVANI ELANGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8325 W INDIAN SCHOOL RD
PHOENIX AZ
85037-2125
US

IV. Provider business mailing address

8325 W INDIAN SCHOOL RD
PHOENIX AZ
85037-2125
US

V. Phone/Fax

Practice location:
  • Phone: 623-245-7353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS018428
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: