Provider Demographics
NPI:1003192774
Name:ELEVULU, CANAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:CANAN
Middle Name:
Last Name:ELEVULU
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:CANAN
Other - Middle Name:
Other - Last Name:TURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 VERNON AVE
Mailing Address - Street 2:APT: 387
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-6705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4128
Practice Address - Country:US
Practice Address - Phone:860-649-8747
Practice Address - Fax:860-649-9748
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist