Provider Demographics
NPI:1669136438
Name:GRIESACKER, ELENI
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:GRIESACKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33564 AUGUSTA WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2782
Mailing Address - Country:US
Mailing Address - Phone:330-518-3624
Mailing Address - Fax:
Practice Address - Street 1:101 KAPPA DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-2809
Practice Address - Country:US
Practice Address - Phone:440-871-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03227979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist