Provider Demographics
NPI:1932407202
Name:ELAM, ALICIA BEATRIX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:BEATRIX
Last Name:ELAM
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 1:2930 MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3569
Mailing Address - Country:US
Mailing Address - Phone:706-394-2187
Mailing Address - Fax:706-955-9773
Practice Address - Street 1:3650 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6520
Practice Address - Country:US
Practice Address - Phone:706-210-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018336183500000X
SC12058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12058OtherSC PHARMACY LICENSE
GARPH018336OtherPHARMACY LICENSE