Provider Demographics
NPI:1811366180
Name:KNOWLES, ELAINE MARY (RPH)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:KNOWLES
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 1:325 OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3680
Mailing Address - Country:US
Mailing Address - Phone:860-506-2266
Mailing Address - Fax:860-506-2266
Practice Address - Street 1:325 OAKLAND ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3680
Practice Address - Country:US
Practice Address - Phone:860-506-2266
Practice Address - Fax:860-506-2266
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0009856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist