Healthcare Provider Details

I. General information

NPI: 1003033101
Provider Name (Legal Business Name): CLIFTON G. ELLIOTT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77395 LANDRY DR
MARINGOUIN LA
70757-3208
US

IV. Provider business mailing address

PO BOX 86
MARINGOUIN LA
70757-0086
US

V. Phone/Fax

Practice location:
  • Phone: 225-625-2353
  • Fax: 225-625-3144
Mailing address:
  • Phone: 225-625-2353
  • Fax: 225-625-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4742IR
License Number StateLA

VIII. Authorized Official

Name: CLIFTON ELLIOTT
Title or Position: OWNER
Credential:
Phone: 225-625-2353