Provider Demographics
NPI:1558811000
Name:STARAL, ELISA W (PHARMD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:W
Last Name:STARAL
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 1:171 W TOWN SQUARE WAY
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-6801
Mailing Address - Country:US
Mailing Address - Phone:414-501-1710
Mailing Address - Fax:414-768-7365
Practice Address - Street 1:171 W TOWN SQUARE WAY
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-6801
Practice Address - Country:US
Practice Address - Phone:414-501-1710
Practice Address - Fax:414-768-7365
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18056-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist