Provider Demographics
NPI:1669071874
Name:THEOPHILOS, ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:THEOPHILOS
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 1:7201 GRAPEVINE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8605
Mailing Address - Country:US
Mailing Address - Phone:817-281-8310
Mailing Address - Fax:817-427-8281
Practice Address - Street 1:7201 GRAPEVINE HWY
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8605
Practice Address - Country:US
Practice Address - Phone:817-281-8310
Practice Address - Fax:817-427-8281
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0466011835P0018X
CO160221835P0018X
TX404341835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist