=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083734149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE C. STRONG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 US 27 S
-----------------------------------------------------
City | LAKE PLACID
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33852-7900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-699-6155
-----------------------------------------------------
Fax | 863-465-9656
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 JOSEPHINE AVE
-----------------------------------------------------
City | LAKE PLACID
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33852-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-465-3524
-----------------------------------------------------
Fax | 863-465-9656
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS28804
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------