Provider Demographics
NPI:1043512353
Name:ELLIOTT, CYRUS BROOKS (RPH)
Entity Type:Individual
Prefix:MR
First Name:CYRUS
Middle Name:BROOKS
Last Name:ELLIOTT
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 1:60 BELL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-6965
Mailing Address - Country:US
Mailing Address - Phone:928-284-1007
Mailing Address - Fax:
Practice Address - Street 1:2300 W HIGHWAY 89A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5344
Practice Address - Country:US
Practice Address - Phone:928-282-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS017508OtherPHARMACIST LIC. #