Provider Demographics
NPI:1417397985
Name:ELLIOTT, KAREN CLIFFORD
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:CLIFFORD
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 HIDDEN GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4576
Mailing Address - Country:US
Mailing Address - Phone:702-768-1378
Mailing Address - Fax:
Practice Address - Street 1:497 HIDDEN GARDEN PL
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4576
Practice Address - Country:US
Practice Address - Phone:702-768-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5776183500000X
CA27630183500000X
AZS05273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist