Basic Information
| Provider Information | |||||||||
| NPI: | 1558359216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELTON | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD, NCPS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26 RYAN LN | ||||||||
| Address2: | |||||||||
| City: | ESKO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557339748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188784813 | ||||||||
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| Practice Location | |||||||||
| Address1: | 927 TRETTEL LN | ||||||||
| Address2: | |||||||||
| City: | CLOQUET | ||||||||
| State: | MN | ||||||||
| PostalCode: | 557201345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2188791227 | ||||||||
| FaxNumber: | 2188783739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 117046-3 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.