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General NPI Number Information
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NPI Number | 1053662700
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Entity Type | Individual
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Provider Name | ELISA MARIE CHI SUPAN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 18220 STATE HIGHWAY 249
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City | HOUSTON
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State | TX
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Zip | 77070-4347
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Country | US
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Telephone | 281-737-1440
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Fax |
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Provider Business Mailing Address
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Address Line | 2666 SKYVIEW GLEN CT
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City | HOUSTON
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State | TX
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Zip | 77047-6818
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Country | US
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Telephone | 856-397-7516
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 42879
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License Number State | TX
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