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General NPI Number Information
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NPI Number | 1710902705
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Entity Type | Organization
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Legal Business Name | ELLIOTTS PHARMACY INC.
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4835 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-2759
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Country | US
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Telephone | 805-460-2609
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Fax | 805-460-2611
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Provider Business Mailing Address
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Address Line | 4835 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422-2759
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Country | US
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Telephone | 805-460-2609
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Fax | 805-460-2611
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Authorized Official
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Title or Position | OWNER
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Name | ASHE WAHBA
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Credential |
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Telephone | 805-460-2614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | PHY46239
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License Number State | CA
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