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NPI Code Detail

MEDICARE: MARY ELLIOTT PHARMD

MEDICARE: MARY ELLIOTT PHARMD
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
1183500000XPharmacistRPH0007700WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RP0007700OTHERWVBOARD OF PHARMACY

General Provider Information

NPI Number : 1912517368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELLIOTT PHARMD
Provider Business Mailing Address
First Line : 11 OVERLOOK DR
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1021
Country : US
Telephone Number : 304-365-0921
Fax Number :
Provider Business Practice Location Address
First Line : 200 EMILY DR
Second Line :
City : CLARKSBURG
State : WV
Zip : 26301-5500
Country : US
Telephone Number : 304-918-6056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2020
Last Update Date : 07/31/2020

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Directions to “ MARY ELLIOTT PHARMD” Practice Location

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