Provider Demographics
NPI:1487728473
Name:STRATTON, ELISABETH DAVIN ROUSE
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:DAVIN ROUSE
Last Name:STRATTON
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 1:532 PLAZA DR APT 110
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3850
Mailing Address - Country:US
Mailing Address - Phone:608-695-0144
Mailing Address - Fax:
Practice Address - Street 1:999 FOURIER DR STE 301
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2914
Practice Address - Country:US
Practice Address - Phone:608-827-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14233-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14233-40OtherPHARMACIST