MEDICARE: DR. ERTIFA BINTA ELIAS PHARMD/ RPH

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	RPH035870	GA
2	183500000X	Pharmacist	072090	NY

General Provider Information

NPI Number	:	1770306516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERTIFA BINTA ELIAS PHARMD/ RPH

Provider Business Mailing Address
First Line	:	3439 ASHFORD DUNWOODY RD NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2546
Country	:	US
Telephone Number	:	770-216-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	3439 ASHFORD DUNWOODY RD NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-2546
Country	:	US
Telephone Number	:	770-216-8605
Fax Number	:

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

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	05/28/2026

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