Provider Demographics
NPI:1619364254
Name:JAMES, ELISE (RPH)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:JAMES
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 1:5604 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8762
Mailing Address - Country:US
Mailing Address - Phone:850-623-0843
Mailing Address - Fax:
Practice Address - Street 1:2180 W NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-9472
Practice Address - Country:US
Practice Address - Phone:850-473-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9702183500000X
FLPS17642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist