Provider Demographics
NPI:1740567304
Name:ELLIOTT, JOHN PETE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PETE
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 1:7151 BLVD 26
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8607
Mailing Address - Country:US
Mailing Address - Phone:817-514-9474
Mailing Address - Fax:
Practice Address - Street 1:7151 BLVD 26
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8607
Practice Address - Country:US
Practice Address - Phone:817-514-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist