Provider Demographics
NPI:1235460155
Name:ELLIOTT, CATHY C
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:C
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PACIFIC BLVD SE
Mailing Address - Street 2:1700 PACIFIC BLVD.
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-4833
Mailing Address - Country:US
Mailing Address - Phone:541-926-5214
Mailing Address - Fax:
Practice Address - Street 1:1700 PACIFIC BLVD SE
Practice Address - Street 2:1700 PACIFIC BLVD.
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-4833
Practice Address - Country:US
Practice Address - Phone:541-926-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0006591183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist