Healthcare Provider Details

I. General information

NPI: 1619267705
Provider Name (Legal Business Name): ELENI K HOTZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 FEEDWIRE RD
DAYTON OH
45440-3970
US

IV. Provider business mailing address

4341 FEEDWIRE RD
DAYTON OH
45440-3970
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-9357
  • Fax:
Mailing address:
  • Phone: 937-439-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03120838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: