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Individual

DR. JOHANNA KRISTIN ELLERUP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PHARMD

Contact information

Practice address
99 N MAPLE ST, NORTH MASSAPEQUA, NY 11758-2636
(516) 509-8185
(516) 799-8286
Mailing address
99 N MAPLE ST, N MASSAPEQUA, NY 11758-2636
(516) 509-8185
(516) 799-8286

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
079733
NY
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
055468
NY

Other

Enumeration date
06/01/2007
Last updated
05/12/2011
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