Provider Demographics
NPI:1679022883
Name:KING, ELISE CEDRICE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:CEDRICE
Last Name:KING
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 1:1203 WESTBANK EXPY
Mailing Address - Street 2:
Mailing Address - City:WESTWEGO
Mailing Address - State:LA
Mailing Address - Zip Code:70094-4755
Mailing Address - Country:US
Mailing Address - Phone:504-371-1061
Mailing Address - Fax:504-371-1062
Practice Address - Street 1:1203 WESTBANK EXPY
Practice Address - Street 2:
Practice Address - City:WESTWEGO
Practice Address - State:LA
Practice Address - Zip Code:70094-4755
Practice Address - Country:US
Practice Address - Phone:504-371-1061
Practice Address - Fax:504-371-1062
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.021783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist