MEDICARE: DR. JOHN ROBERT ELKO JR. PHARM.D.

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	RP0008277	WV

General Provider Information

NPI Number	:	1710456363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ROBERT ELKO JR. PHARM.D.

Provider Business Mailing Address
First Line	:	120 E MAIN ST
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-1303
Country	:	US
Telephone Number	:	304-782-2171
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E MAIN ST
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-1303
Country	:	US
Telephone Number	:	304-782-2171
Fax Number	:

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

Provider Enumeration Date	:	11/13/2018
Last Update Date	:	11/13/2018

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