Provider Demographics
NPI:1386948636
Name:DER, ELAINE H (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:H
Last Name:DER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:H
Other - Last Name:DER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:732 MOTT ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4237
Mailing Address - Country:US
Mailing Address - Phone:818-837-3775
Mailing Address - Fax:818-837-3799
Practice Address - Street 1:732 MOTT ST
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4237
Practice Address - Country:US
Practice Address - Phone:818-837-3775
Practice Address - Fax:818-837-3799
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA474311835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist