Elisa Marie CHI Supan, PHARM.D.

Key facts

NPI

1053662700

Entity type

Individual (NPI type 1)

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X

License

42879 (TX)

Practice address

18220 State Highway 249
Houston, TX 77070-4347

Phone

(281) 737-1440

NPI assigned

Sep 20, 2012

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Doctor of Pharmacy

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 20, 2012.

{
    "created_epoch": "1348099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348099200000",
    "number": "1053662700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2666 SKYVIEW GLEN CT",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770476818",
            "telephone_number": "856-397-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18220 STATE HIGHWAY 249",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770704347",
            "telephone_number": "281-737-1440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPAN",
        "first_name": "ELISA",
        "middle_name": "MARIE CHI",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-20",
        "last_updated": "2012-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "42879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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