Healthcare Provider Details

I. General information

NPI: 1528410073
Provider Name (Legal Business Name): AMANDA SANNA ELOMA PHARMD, BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 04/30/2024
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

451 CLARKSON AVE
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-1067
  • Fax:
Mailing address:
  • Phone: 718-245-1067
  • Fax: 718-245-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number061195
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number061195
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: