Healthcare Provider Details

I. General information

NPI: 1821107616
Provider Name (Legal Business Name): ELSA IGLESIAS R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/24/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 UNION VALLEY RD
WEST MILFORD NJ
07480-1354
US

IV. Provider business mailing address

PO BOX 856
WEST MILFORD NJ
07480-0856
US

V. Phone/Fax

Practice location:
  • Phone: 973-728-3172
  • Fax:
Mailing address:
  • Phone: 973-728-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02247400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: