Provider Demographics
NPI:1174510739
Name:ELIAS, VICTORIA DENISE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:DENISE
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10289 S 49TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-9057
Mailing Address - Country:US
Mailing Address - Phone:918-960-8537
Mailing Address - Fax:
Practice Address - Street 1:715 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-3553
Practice Address - Country:US
Practice Address - Phone:918-770-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist