Provider Demographics
NPI:1972120202
Name:POILLON, ELISSA MICHELLE (CPHT)
Entity Type:Individual
Prefix:MISS
First Name:ELISSA
Middle Name:MICHELLE
Last Name:POILLON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10431 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-9658
Mailing Address - Country:US
Mailing Address - Phone:541-613-7632
Mailing Address - Fax:
Practice Address - Street 1:230 ROWE RD
Practice Address - Street 2:
Practice Address - City:WHEELER
Practice Address - State:OR
Practice Address - Zip Code:97147-0035
Practice Address - Country:US
Practice Address - Phone:844-715-2999
Practice Address - Fax:844-715-3299
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0002057183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician