Provider Demographics
NPI:1962037408
Name:HOFFMAN, ELYCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELYCE
Middle Name:
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17165 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-5917
Mailing Address - Country:US
Mailing Address - Phone:262-797-9074
Mailing Address - Fax:262-797-9232
Practice Address - Street 1:17165 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-5917
Practice Address - Country:US
Practice Address - Phone:262-797-9074
Practice Address - Fax:262-797-9232
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16792-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist