Provider Demographics
NPI:1174003487
Name:ELLER, PAIGE (PHARMD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:ELLER
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 1:4128 VINYARD CT
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5062
Mailing Address - Country:US
Mailing Address - Phone:404-514-3269
Mailing Address - Fax:
Practice Address - Street 1:2090 BAKER RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4600
Practice Address - Country:US
Practice Address - Phone:678-331-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030728183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist