Provider Demographics
NPI:1689901340
Name:ELLIOTT, PAUL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 HWY 6 SOUTH
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-980-5790
Mailing Address - Fax:281-980-5826
Practice Address - Street 1:3316 HWY 6 SOUTH
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-980-5790
Practice Address - Fax:281-980-5826
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist