Healthcare Provider Details

I. General information

NPI: 1952618746
Provider Name (Legal Business Name): ELMER M SANTOS BS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6798 SHALLOWFORD RD
LEWISVILLE NC
27023-9724
US

IV. Provider business mailing address

203 PARKVIEW LN
ADVANCE NC
27006-8791
US

V. Phone/Fax

Practice location:
  • Phone: 336-945-2106
  • Fax: 336-946-2206
Mailing address:
  • Phone: 336-391-8533
  • Fax: 336-946-2206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19643
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: