Provider Demographics
NPI:1689361115
Name:ELLIOTT, GRACIE ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GRACIE
Middle Name:ANN
Last Name:ELLIOTT
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 1:505 GANTS RD # 2
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8061
Mailing Address - Country:US
Mailing Address - Phone:843-409-6462
Mailing Address - Fax:
Practice Address - Street 1:505 GANTS RD # 2
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8061
Practice Address - Country:US
Practice Address - Phone:843-409-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist