Provider Demographics
NPI:1295143790
Name:ELLIOTT, STEPHANIE GORDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:GORDON
Last Name:ELLIOTT
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 1:14 E 27TH ST N
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219-3624
Mailing Address - Country:US
Mailing Address - Phone:276-523-1713
Mailing Address - Fax:273-523-2931
Practice Address - Street 1:14 E 27TH ST N
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3624
Practice Address - Country:US
Practice Address - Phone:276-523-1713
Practice Address - Fax:273-523-2931
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202212106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist