Provider Demographics
NPI:1164763223
Name:ELIAS, MARY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45352
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-0352
Mailing Address - Country:US
Mailing Address - Phone:917-648-0781
Mailing Address - Fax:
Practice Address - Street 1:20704 OSAGE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-3736
Practice Address - Country:US
Practice Address - Phone:917-648-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist