Provider Demographics
NPI:1336441716
Name:HESTER, ELSIE Y
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:Y
Last Name:HESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKKI
Other - Middle Name:
Other - Last Name:HESTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2689 SHADOW BLUFF DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2567
Mailing Address - Country:US
Mailing Address - Phone:770-973-0857
Mailing Address - Fax:
Practice Address - Street 1:4401 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3193
Practice Address - Country:US
Practice Address - Phone:770-640-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014381183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist