Provider Demographics
NPI:1821371634
Name:HUBBARD, ELISE (RPH)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:HUBBARD
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 1:4425 PLUM CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9315
Mailing Address - Country:US
Mailing Address - Phone:269-429-2615
Mailing Address - Fax:
Practice Address - Street 1:4425 PLUM CREEK LN
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9315
Practice Address - Country:US
Practice Address - Phone:269-429-2615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist