Provider Demographics
NPI:1033570478
Name:HOROSKO, ELISA
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:HOROSKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6740 APPLE BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-7483
Mailing Address - Country:US
Mailing Address - Phone:517-745-7155
Mailing Address - Fax:
Practice Address - Street 1:1013 S KALAMAZOO ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-8258
Practice Address - Country:US
Practice Address - Phone:269-415-6014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-13
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037251183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist