Provider Demographics
NPI:1235473406
Name:DREPAUL, ELIZABETH ASHLEY (PHARM D)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:DREPAUL
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 1:3636 221ST ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2229
Mailing Address - Country:US
Mailing Address - Phone:917-710-2588
Mailing Address - Fax:
Practice Address - Street 1:3636 221ST ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2229
Practice Address - Country:US
Practice Address - Phone:917-710-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0571671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist