Provider Demographics
NPI:1407141401
Name:LANDA, ELLIOT (RPH)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:
Last Name:LANDA
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 1:8 HUXLEY CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2140
Mailing Address - Country:US
Mailing Address - Phone:908-216-6680
Mailing Address - Fax:732-536-5696
Practice Address - Street 1:703 GINESI DR
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1235
Practice Address - Country:US
Practice Address - Phone:732-617-8686
Practice Address - Fax:732-617-8321
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01958900183500000X
NY033399-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist