Healthcare Provider Details

I. General information

NPI: 1154410835
Provider Name (Legal Business Name): ELYSE JEANNETTE HOFFMAN PHARMD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD STE 1070
WEST BLOOMFIELD MI
48323-2185
US

IV. Provider business mailing address

30257 MAYFAIR DR
FARMINGTON HILLS MI
48331-2159
US

V. Phone/Fax

Practice location:
  • Phone: 248-668-1212
  • Fax:
Mailing address:
  • Phone: 248-788-0479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027595
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: