Provider Demographics
NPI:1821447319
Name:ELKOMY, ALAA (RPH)
Entity Type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:ELKOMY
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 1:215 OAK GROVE ST
Mailing Address - Street 2:APT 201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3342
Mailing Address - Country:US
Mailing Address - Phone:612-354-1175
Mailing Address - Fax:
Practice Address - Street 1:2021 MARKET DR
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-7546
Practice Address - Country:US
Practice Address - Phone:651-439-0992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist