Provider Demographics
NPI:1578187324
Name:OSLER, ELISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:OSLER
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 1:1514 TALL GRASS PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-6864
Mailing Address - Country:US
Mailing Address - Phone:574-315-8335
Mailing Address - Fax:
Practice Address - Street 1:2101 E IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-9156
Practice Address - Country:US
Practice Address - Phone:574-291-1303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26026785A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist