Provider Demographics
NPI:1104158468
Name:ELROD, MICHAEL ALAN (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:ELROD
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3103
Mailing Address - Country:US
Mailing Address - Phone:516-873-1998
Mailing Address - Fax:516-873-7235
Practice Address - Street 1:216 GLEN COVE AVE
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1630
Practice Address - Country:US
Practice Address - Phone:516-334-2847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034351183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist