Provider Demographics
NPI:1689959272
Name:WIGHT, ELISCIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISCIA
Middle Name:
Last Name:WIGHT
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 1:9049 PINE MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-1124
Mailing Address - Country:US
Mailing Address - Phone:702-370-0287
Mailing Address - Fax:
Practice Address - Street 1:101 E. LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89005
Practice Address - Country:US
Practice Address - Phone:702-566-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17013183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist