Provider Demographics
NPI:1699081026
Name:ELLIOT, PAMELA M (RPH)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 SIEGEN LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1943
Mailing Address - Country:US
Mailing Address - Phone:225-766-8803
Mailing Address - Fax:225-766-8804
Practice Address - Street 1:8601 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1943
Practice Address - Country:US
Practice Address - Phone:225-766-8803
Practice Address - Fax:225-766-8804
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist