Provider Demographics
NPI:1235330028
Name:ELDER, EDMUND JOSEPH JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:JOSEPH
Last Name:ELDER
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2222
Mailing Address - Country:US
Mailing Address - Phone:608-890-1198
Mailing Address - Fax:
Practice Address - Street 1:777 HIGHLAND AVE
Practice Address - Street 2:UW-MADISON SCHOOL OF PHARMACY RENNEBOHM HALL
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2222
Practice Address - Country:US
Practice Address - Phone:608-890-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6368183500000X
WI16206-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist