Individual
MS. DIANE L ELIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
15602 N DALE MABRY HWY, TAMPA, FL 33618-1606
(813) 264-7722
(813) 963-5823
Mailing address
12359 WITHERIDGE DR, TAMPA, FL 33624-5728
(813) 968-3334
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS31971
FL
Other
Enumeration date
01/11/2012
Last updated
01/11/2012
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