Provider Demographics
NPI:1194482000
Name:VELJACIC, ELVIS
Entity type:Individual
Prefix:
First Name:ELVIS
Middle Name:
Last Name:VELJACIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FAIRWOOD DR APT 110
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4950
Mailing Address - Country:US
Mailing Address - Phone:315-941-8643
Mailing Address - Fax:
Practice Address - Street 1:45 BECKER RD STE D
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9211
Practice Address - Country:US
Practice Address - Phone:585-486-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-27
Last Update Date:2021-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI068060-01183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist