=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255448296
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELLIOTT PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14077 FM 849
-----------------------------------------------------
City | LINDALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75771-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-882-3312
-----------------------------------------------------
Fax | 903-882-8579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14077 FM 849
-----------------------------------------------------
City | LINDALE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75771-5160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-882-3312
-----------------------------------------------------
Fax | 903-882-8579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. APRIL CECELIA BONDS
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 903-882-3312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 16420
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------