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General NPI Number Information
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NPI Number | 1023393196
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Entity Type | Individual
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Provider Name | DR. TAREK H ELAWA
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 950 S KOELLER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6175
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Country | US
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Telephone | 920-303-1712
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Fax |
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Provider Business Mailing Address
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Address Line | 131 WYLDEWOOD DR APT # K202
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City | OSHKOSH
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State | WI
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Zip | 54904-8649
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Country | US
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Telephone | 414-335-4608
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16160-40
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License Number State | WI
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