Provider Demographics
NPI:1003138702
Name:BULKU, ELIDA (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:ELIDA
Middle Name:
Last Name:BULKU
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 1:589 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6020
Mailing Address - Country:US
Mailing Address - Phone:347-955-3029
Mailing Address - Fax:
Practice Address - Street 1:2535 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4414
Practice Address - Country:US
Practice Address - Phone:917-933-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052516183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist