Basic Information
| Provider Information | |||||||||
| NPI: | 1801353560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLER | ||||||||
| FirstName: | FLORENTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 478 | ||||||||
| Address2: | |||||||||
| City: | RUSHVILLE | ||||||||
| State: | NE | ||||||||
| PostalCode: | 693600478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158012441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 607 INDIAN HEALTH RD | ||||||||
| Address2: | |||||||||
| City: | PINE RIDGE | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577703169 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6058673192 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2019 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 2015020548 | MO | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.