Provider Demographics
NPI:1952618746
Name:SANTOS, ELMER M (BS)
Entity Type:Individual
Prefix:MR
First Name:ELMER
Middle Name:M
Last Name:SANTOS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-8791
Mailing Address - Country:US
Mailing Address - Phone:336-391-8533
Mailing Address - Fax:336-946-2206
Practice Address - Street 1:6798 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9724
Practice Address - Country:US
Practice Address - Phone:336-945-2106
Practice Address - Fax:336-946-2206
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist