Healthcare Provider Details

I. General information

NPI: 1821385667
Provider Name (Legal Business Name): ELIM PHARMACEUTICAL CONSULTANTS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16125 JUANITA-WOOD WAY NE UNIT 2214
BOTHELL WA
98011-9444
US

IV. Provider business mailing address

16125 JUANITA-WOOD WAY NE UNIT 2214
BOTHELL WA
98011-9444
US

V. Phone/Fax

Practice location:
  • Phone: 425-908-7045
  • Fax:
Mailing address:
  • Phone: 425-908-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number602856613
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberPH00045962
License Number StateWA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. GRACE GANA
Title or Position: CLINICAL PHARMACIST CONSULTANT
Credential: RPH, CGP
Phone: 425-908-7045