Provider Demographics
NPI:1497049357
Name:COCCHIARELLA, ELISA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:MARIE
Last Name:COCCHIARELLA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 S INDEPENDENCE BLVD
Mailing Address - Street 2:TARGET 1105
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-4747
Mailing Address - Country:US
Mailing Address - Phone:757-416-1785
Mailing Address - Fax:757-416-1785
Practice Address - Street 1:2060 S INDEPENDENCE BLVD
Practice Address - Street 2:TARGET 1105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4747
Practice Address - Country:US
Practice Address - Phone:757-416-1785
Practice Address - Fax:757-416-1785
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist