Provider Demographics
NPI:1710581095
Name:ELLIOTT, REECA L (RPH)
Entity Type:Individual
Prefix:
First Name:REECA
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CITY AVE S
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-2520
Mailing Address - Country:US
Mailing Address - Phone:662-837-4444
Mailing Address - Fax:662-837-4443
Practice Address - Street 1:750 CITY AVE S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-2520
Practice Address - Country:US
Practice Address - Phone:662-837-4444
Practice Address - Fax:662-837-4443
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-26
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE82151835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty