Provider Demographics
NPI:1407697675
Name:ILIOFF, EDWARD JAY
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAY
Last Name:ILIOFF
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 1:2556 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-2610
Mailing Address - Country:US
Mailing Address - Phone:410-287-8887
Mailing Address - Fax:
Practice Address - Street 1:2556 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-2610
Practice Address - Country:US
Practice Address - Phone:410-287-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15611183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist