Provider Demographics
NPI:1205457660
Name:ELATTAR, RAMI (RPH, BCOP)
Entity type:Individual
Prefix:
First Name:RAMI
Middle Name:
Last Name:ELATTAR
Suffix:
Gender:M
Credentials:RPH, BCOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 S HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2510
Mailing Address - Country:US
Mailing Address - Phone:617-943-3646
Mailing Address - Fax:
Practice Address - Street 1:850 FAIR OAKS AVE STE 300
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3929
Practice Address - Country:US
Practice Address - Phone:805-474-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA726141835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA72614OtherCALIFORNIA BOARD OF PHARMACY - REGISTERED PHARMACIST LICENSE
5151457OtherBOARD OF PHARMACY SPECIALTIES - BOARD CERTIFIED ONCOLOGY PHARMACIST