Provider Demographics
NPI:1174858260
Name:ELWOOD, EARL DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:EARL
Middle Name:DEAN
Last Name:ELWOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9700
Mailing Address - Country:US
Mailing Address - Phone:623-907-4838
Mailing Address - Fax:623-907-4938
Practice Address - Street 1:500 S. 99TH AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353
Practice Address - Country:US
Practice Address - Phone:623-907-4938
Practice Address - Fax:623-907-4938
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7347183500000X
WY1904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist