Provider Demographics
NPI:1982949905
Name:GIFFEN, ELLIOTT M II (RPH)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:M
Last Name:GIFFEN
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5008
Mailing Address - Country:US
Mailing Address - Phone:704-523-8608
Mailing Address - Fax:704-523-8619
Practice Address - Street 1:2334 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5008
Practice Address - Country:US
Practice Address - Phone:704-523-8608
Practice Address - Fax:704-523-8619
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4615OtherN.C. BOARD OF PHARMACY