Provider Demographics
NPI:1730815010
Name:ELLIOTT, CHRIS (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3638
Mailing Address - Country:US
Mailing Address - Phone:662-287-8062
Mailing Address - Fax:662-287-6429
Practice Address - Street 1:1815 E SHILOH RD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3638
Practice Address - Country:US
Practice Address - Phone:662-287-8062
Practice Address - Fax:662-287-6429
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010064183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist