Provider Demographics
NPI:1720655509
Name:KING, ELISE
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:KING
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 1:922 SENATE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4017
Mailing Address - Country:US
Mailing Address - Phone:937-610-3051
Mailing Address - Fax:937-610-3048
Practice Address - Street 1:922 SENATE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4017
Practice Address - Country:US
Practice Address - Phone:937-610-3051
Practice Address - Fax:937-610-3048
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy