Provider Demographics
NPI:1427402312
Name:CASELLAS, ELBA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:
Last Name:CASELLAS
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 1:5535 MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-7332
Mailing Address - Country:US
Mailing Address - Phone:813-889-9779
Mailing Address - Fax:813-889-9724
Practice Address - Street 1:5535 MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7332
Practice Address - Country:US
Practice Address - Phone:813-997-9779
Practice Address - Fax:813-889-9724
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21277183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5938120001Medicare NSC