Provider Demographics
NPI:1346369881
Name:ELTZROTH, DARLENE (PHARM D)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:ELTZROTH
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 1:1228 WYNDHAM FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1144
Mailing Address - Country:US
Mailing Address - Phone:859-223-4260
Mailing Address - Fax:859-275-1679
Practice Address - Street 1:278 SOUTHLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1940
Practice Address - Country:US
Practice Address - Phone:859-260-6197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9578183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist