Provider Demographics
NPI:1992341036
Name:ELSTEN, BRIAN JAY (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAY
Last Name:ELSTEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5262
Mailing Address - Country:US
Mailing Address - Phone:765-644-2421
Mailing Address - Fax:765-644-7734
Practice Address - Street 1:3050 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5262
Practice Address - Country:US
Practice Address - Phone:765-644-2421
Practice Address - Fax:765-644-7734
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist