Provider Demographics
NPI:1306169321
Name:ELAHIPANAH, PARISA
Entity type:Individual
Prefix:MRS
First Name:PARISA
Middle Name:
Last Name:ELAHIPANAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2413
Mailing Address - Country:US
Mailing Address - Phone:631-331-3162
Mailing Address - Fax:631-331-2795
Practice Address - Street 1:302 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2413
Practice Address - Country:US
Practice Address - Phone:516-770-3985
Practice Address - Fax:631-331-2795
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist