Healthcare Provider Details

I. General information

NPI: 1205457660
Provider Name (Legal Business Name): RAMI ELATTAR RPH, BCOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 FAIR OAKS AVE STE 300
ARROYO GRANDE CA
93420-3929
US

IV. Provider business mailing address

2815 S HOLT AVE
LOS ANGELES CA
90034-2510
US

V. Phone/Fax

Practice location:
  • Phone: 805-474-5322
  • Fax:
Mailing address:
  • Phone: 617-943-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number72614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: