Provider Demographics
NPI:1366684029
Name:ELWAN, AKRAM
Entity Type:Individual
Prefix:
First Name:AKRAM
Middle Name:
Last Name:ELWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:AKRAM
Other - Middle Name:
Other - Last Name:ELWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:110 LEANING TREE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3007
Mailing Address - Country:US
Mailing Address - Phone:803-708-2753
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY ROAD
Practice Address - Street 2:WM. JENNINGS DORN MEDICAL CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist