Provider Demographics
NPI:1366082638
Name:ZHONG, ELAINE LILY (PHARMD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:LILY
Last Name:ZHONG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29172-3025
Mailing Address - Country:US
Mailing Address - Phone:803-462-5005
Mailing Address - Fax:
Practice Address - Street 1:4500 12TH STREET EXT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29172-3025
Practice Address - Country:US
Practice Address - Phone:803-462-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC42230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist