MEDICARE: ELISA SELDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	202212417	VA

General Provider Information

NPI Number	:	1376948745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA SELDON

Provider Business Mailing Address
First Line	:	721 SOUTHPARK BLVD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3606
Country	:	US
Telephone Number	:	804-520-2280
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 SOUTHPARK BLVD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3606
Country	:	US
Telephone Number	:	804-520-2280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2014
Last Update Date	:	10/28/2014

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Directions to “ ELISA SELDON ” Practice Location

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