Provider Demographics
NPI:1508267501
Name:FROMMELT, ELIZABETH KAY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:KAY
Last Name:FROMMELT
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:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:BURNS
Mailing Address - State:OR
Mailing Address - Zip Code:97720-0812
Mailing Address - Country:US
Mailing Address - Phone:541-413-2860
Mailing Address - Fax:541-413-2960
Practice Address - Street 1:191 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-2204
Practice Address - Country:US
Practice Address - Phone:541-413-2860
Practice Address - Fax:541-413-2960
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00105401835P0018X
ORRPH-0010540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0010540OtherPRH LICENSE