Provider Demographics
NPI:1972841245
Name:ELMORE, DANA P (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:P
Last Name:ELMORE
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 1:2095 W LAKE HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-9217
Mailing Address - Country:US
Mailing Address - Phone:863-293-4845
Mailing Address - Fax:863-325-8271
Practice Address - Street 1:6031 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-4115
Practice Address - Country:US
Practice Address - Phone:863-324-1557
Practice Address - Fax:863-325-8271
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist