Provider Demographics
NPI:1720395973
Name:ELLIOTT, MONICA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:EDWARDS
Other - Last Name:DOWNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:25800 HIGHWAY 171
Mailing Address - Street 2:
Mailing Address - City:MANY
Mailing Address - State:LA
Mailing Address - Zip Code:71449
Mailing Address - Country:US
Mailing Address - Phone:318-256-6378
Mailing Address - Fax:318-256-6443
Practice Address - Street 1:25800 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449
Practice Address - Country:US
Practice Address - Phone:318-256-6378
Practice Address - Fax:318-256-6443
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist