Provider Demographics
NPI:1902494180
Name:ELKAREH, NOEL ROSE
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:ROSE
Last Name:ELKAREH
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 1:1270 SPRING ST NW UNIT 547
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3087
Mailing Address - Country:US
Mailing Address - Phone:678-287-9509
Mailing Address - Fax:
Practice Address - Street 1:1035 LOWER FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1132
Practice Address - Country:US
Practice Address - Phone:678-423-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist