Carl Jeffrey Eliason
Organization Active NPI Pharmacist · Superior, WI
NPI 1205969102 · NPPES record last updated Sep 5, 2008
Key facts
- NPI
- 1205969102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacist 183500000X
- License
- 10055040 (WI)
- Legal business name
- CARL JEFFREY ELIASON
- Practice address
- 1124 Belknap St
Superior, WI 54880-2856 - Phone
- (715) 394-7765
- Fax
- (715) 394-7765
- NPI assigned
- Mar 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Carl Jeff Eliason, PHARMACIST
- Title
- Owner Pharmacist
- Phone
- (715) 394-7765
National Provider Directory
Locations
1124 Belknap St
Superior, WI 54880
Phone (715) 394-7765
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 10055040 | WI | Yes |
| Customized Equipment (DME) | 332BC3200X | |||
| Pharmacy | 333600000X | 7047042 | WI |
Addresses
Primary practice location
1124 Belknap St
Superior, WI 54880-2856
Mailing address
1124 Belknap St
Superior, WI 54880-2856
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33075100 | Medicaid | WI |
Other names
- Peoples Drug
Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.