Provider Demographics
NPI:1760039150
Name:ATABOONG, ELIZABETH E (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:ATABOONG
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 1:1314 W MCDERMOTT DR STE 106-530
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3021
Mailing Address - Country:US
Mailing Address - Phone:469-366-3957
Mailing Address - Fax:469-366-3944
Practice Address - Street 1:6750 MURPHY RD
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2800
Practice Address - Country:US
Practice Address - Phone:469-366-3957
Practice Address - Fax:469-366-3944
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist