Healthcare Provider Details

I. General information

NPI: 1316860265
Provider Name (Legal Business Name): ELLIOTT PONZE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

421 LIGHTHOUSE DR
PALM BEACH GARDENS FL
33410-4836
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7300
  • Fax:
Mailing address:
  • Phone: 561-215-4927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: