Provider Demographics
NPI:1417256983
Name:ELCOCK, ANITA CHARLENE (RPH)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CHARLENE
Last Name:ELCOCK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4223
Mailing Address - Country:US
Mailing Address - Phone:804-225-1340
Mailing Address - Fax:804-225-8072
Practice Address - Street 1:520 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4223
Practice Address - Country:US
Practice Address - Phone:804-225-1340
Practice Address - Fax:804-225-8072
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist