Provider Demographics
NPI:1760817589
Name:GOLUS, ELISABETH (RPH)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:GOLUS
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 1:29101 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5417
Mailing Address - Country:US
Mailing Address - Phone:248-546-8076
Mailing Address - Fax:248-545-6837
Practice Address - Street 1:29101 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5417
Practice Address - Country:US
Practice Address - Phone:248-546-8076
Practice Address - Fax:248-545-6837
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist