Provider Demographics
NPI:1124574900
Name:ELOKSH, NASR
Entity Type:Individual
Prefix:
First Name:NASR
Middle Name:
Last Name:ELOKSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14785 RUNNYMEADE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-2540
Mailing Address - Country:US
Mailing Address - Phone:248-707-4500
Mailing Address - Fax:
Practice Address - Street 1:30551 STEPHENSON HWY STE 1
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1648
Practice Address - Country:US
Practice Address - Phone:248-268-4531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist