Healthcare Provider Details

I. General information

NPI: 1801353560
Provider Name (Legal Business Name): FLORENTINA ELLER PHARMD, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 INDIAN HEALTH RD
PINE RIDGE SD
57770-3169
US

IV. Provider business mailing address

PO BOX 478
RUSHVILLE NE
69360-0478
US

V. Phone/Fax

Practice location:
  • Phone: 605-867-3192
  • Fax:
Mailing address:
  • Phone: 615-801-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2015020548
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: