Provider Demographics
NPI:1083734149
Name:STRONG, ELAINE C
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:C
Last Name:STRONG
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 1:137 JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-2502
Mailing Address - Country:US
Mailing Address - Phone:863-465-3524
Mailing Address - Fax:863-465-9656
Practice Address - Street 1:204 US 27 S
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7900
Practice Address - Country:US
Practice Address - Phone:863-699-6155
Practice Address - Fax:863-465-9656
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28804183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist