Provider Demographics
NPI:1063699486
Name:ELFELDT, SAURY DAMARIS (RPH)
Entity type:Individual
Prefix:MRS
First Name:SAURY
Middle Name:DAMARIS
Last Name:ELFELDT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1617
Mailing Address - Country:US
Mailing Address - Phone:518-477-8526
Mailing Address - Fax:518-477-5414
Practice Address - Street 1:596 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1617
Practice Address - Country:US
Practice Address - Phone:518-477-8526
Practice Address - Fax:518-477-5414
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040759-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00532114Medicaid