Provider Demographics
NPI:1861748881
Name:ELLIOTT, MICHELLE W (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:101 SOUTHWESTERN DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4221
Mailing Address - Country:US
Mailing Address - Phone:716-720-5709
Mailing Address - Fax:
Practice Address - Street 1:74 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2508
Practice Address - Country:US
Practice Address - Phone:814-723-4450
Practice Address - Fax:855-263-0226
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054897183500000X
PARP450419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist