Provider Demographics
NPI:1306187869
Name:SHLOM, ELIZABETH (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SHLOM
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LOOKOUT PL
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1201
Mailing Address - Country:US
Mailing Address - Phone:212-506-5448
Mailing Address - Fax:212-541-9032
Practice Address - Street 1:21 LOOKOUT PL
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1201
Practice Address - Country:US
Practice Address - Phone:212-506-5448
Practice Address - Fax:212-541-9032
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039214-11835P1200X
CA401211835P1200X
PARP031973L1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy