Healthcare Provider Details

I. General information

NPI: 1154662997
Provider Name (Legal Business Name): ELIDA OLIVARRI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HWY 290 E
ELGIN TX
78621-2519
US

IV. Provider business mailing address

12829 THOMAS JEFFERSON ST
MANOR TX
78653-3921
US

V. Phone/Fax

Practice location:
  • Phone: 512-285-4719
  • Fax: 512-281-0507
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46495
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: