Healthcare Provider Details

I. General information

NPI: 1376227728
Provider Name (Legal Business Name): ELISA WORLEDGE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 E MONTVIEW BLVD
AURORA CO
80045-2605
US

IV. Provider business mailing address

12850 E MONTVIEW BLVD
AURORA CO
80045-2605
US

V. Phone/Fax

Practice location:
  • Phone: 916-718-8404
  • Fax:
Mailing address:
  • Phone: 916-718-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number0024191
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: