Provider Demographics
NPI:1326260357
Name:ELDREDGE, MARK RICHARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:ELDREDGE
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 1:13251 PHELPS
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-1278
Mailing Address - Country:US
Mailing Address - Phone:734-284-2122
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111
Practice Address - Country:US
Practice Address - Phone:734-699-2075
Practice Address - Fax:734-699-2075
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist