Provider Demographics
NPI:1891060356
Name:TARDIFF, ELAINE K (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:K
Last Name:TARDIFF
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 1:9650 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4115
Mailing Address - Country:US
Mailing Address - Phone:804-273-9276
Mailing Address - Fax:804-727-3061
Practice Address - Street 1:9650 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4115
Practice Address - Country:US
Practice Address - Phone:804-273-9276
Practice Address - Fax:804-727-3061
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist