Provider Demographics
NPI:1093712127
Name:NASTASE, ELLEN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:NASTASE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4403 SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1576
Mailing Address - Country:US
Mailing Address - Phone:717-651-9653
Mailing Address - Fax:
Practice Address - Street 1:5125 JONESTOWN ROAD
Practice Address - Street 2:WEIS PHARMACY
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-540-3906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035428-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202206848OtherVIRGINIA STATE RPH LICENS
WVRP0006732OtherWV RPH LICENSE
MD12252OtherMD RPH LICENSE
PARP-035428-LOtherSTATE LICENSE
PARPI002512OtherIMMUNIZER