Provider Demographics
NPI:1437497815
Name:COIL, ELENA DE JESUS (RPH)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:DE JESUS
Last Name:COIL
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 1:375 ROCKBRIDGE RD NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8225
Mailing Address - Country:US
Mailing Address - Phone:770-806-4045
Mailing Address - Fax:770-806-4050
Practice Address - Street 1:375 ROCKBRIDGE RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8225
Practice Address - Country:US
Practice Address - Phone:770-806-4045
Practice Address - Fax:770-806-4050
Is Sole Proprietor?:No
Enumeration Date:2013-01-20
Last Update Date:2013-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist