Provider Demographics
NPI:1679076582
Name:ELIAS, ROBERT TODD
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TODD
Last Name:ELIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3317
Mailing Address - Country:US
Mailing Address - Phone:918-540-9544
Mailing Address - Fax:
Practice Address - Street 1:910 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-3317
Practice Address - Country:US
Practice Address - Phone:918-540-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist