Provider Demographics
NPI:1942583430
Name:DANCY, ELIZABETH B
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:B
Last Name:DANCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24382 MUIRLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3679
Mailing Address - Country:US
Mailing Address - Phone:949-598-9088
Mailing Address - Fax:949-598-9136
Practice Address - Street 1:24382 MUIRLANDS BLVD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3679
Practice Address - Country:US
Practice Address - Phone:949-598-9088
Practice Address - Fax:949-598-9136
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist