Provider Demographics
NPI:1659735264
Name:ELMAN, PETER (RPH,PD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ELMAN
Suffix:
Gender:M
Credentials:RPH,PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1526
Mailing Address - Country:US
Mailing Address - Phone:860-388-1045
Mailing Address - Fax:860-395-2412
Practice Address - Street 1:519 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1526
Practice Address - Country:US
Practice Address - Phone:860-388-1045
Practice Address - Fax:860-395-2412
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist