Healthcare Provider Details

I. General information

NPI: 1770306516
Provider Name (Legal Business Name): ERTIFA BINTA ELIAS PHARMD/ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 ASHFORD DUNWOODY RD NE
BROOKHAVEN GA
30319-2546
US

IV. Provider business mailing address

3439 ASHFORD DUNWOODY RD NE
BROOKHAVEN GA
30319-2546
US

V. Phone/Fax

Practice location:
  • Phone: 770-216-8605
  • Fax:
Mailing address:
  • Phone: 770-216-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035870
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: