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General NPI Number Information
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NPI Number | 1790721793
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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 | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4825 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 | 888-900-7878
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Fax | 877-430-7695
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Provider Business Mailing Address
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Address Line | 4825 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 | 888-900-7878
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Fax | 877-430-7695
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. ASHE WAHBA
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Credential |
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Telephone | 888-900-7878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 102015
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License Number State | CA
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