Provider Demographics
NPI:1962169870
Name:DERVISHI, ELVIRA (PHARM-D)
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:DERVISHI
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SOLON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3702
Mailing Address - Country:US
Mailing Address - Phone:440-439-5766
Mailing Address - Fax:
Practice Address - Street 1:140 SOLON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3702
Practice Address - Country:US
Practice Address - Phone:440-439-5766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist