Provider Demographics
NPI:1619197076
Name:ELSE, DEBORAH LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:ELSE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 FAIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1013
Mailing Address - Country:US
Mailing Address - Phone:360-223-1266
Mailing Address - Fax:
Practice Address - Street 1:503 E HANCOCK AVE
Practice Address - Street 2:ENVISION TELEPHARMACY
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-3219
Practice Address - Country:US
Practice Address - Phone:432-897-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46152183500000X
TX38109183500000X
IN26020109A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist