Provider Demographics
NPI:1902899107
Name:ELLIOT, ELLIE SR (PHARMD, BCPP)
Entity type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:SR
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:PHARMD, BCPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E, 24TH STREET
Mailing Address - Street 2:CENTER FOR BEHAVIORAL MEDICINE
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108
Mailing Address - Country:US
Mailing Address - Phone:816-512-7477
Mailing Address - Fax:816-512-7486
Practice Address - Street 1:1000 E, 24TH STREET
Practice Address - Street 2:CENTER FOR BEHAVIORAL MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:816-512-7477
Practice Address - Fax:816-512-7486
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPH0450551835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric