Provider Demographics
NPI:1124104179
Name:ELKINS, DANNY K (RPH)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:K
Last Name:ELKINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-3904
Mailing Address - Country:US
Mailing Address - Phone:903-628-1000
Mailing Address - Fax:
Practice Address - Street 1:134 HWY 82 WEST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570
Practice Address - Country:US
Practice Address - Phone:903-628-5505
Practice Address - Fax:903-628-3565
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142590Medicaid