Provider Demographics
NPI:1730234089
Name:CLASS, ELSA M
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:M
Last Name:CLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F-11
Mailing Address - Street 2:URB LA MARGARITA 2
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751
Mailing Address - Country:US
Mailing Address - Phone:787-824-3676
Mailing Address - Fax:
Practice Address - Street 1:F-11
Practice Address - Street 2:URB LA MARGARITA 2
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2703
Practice Address - Country:US
Practice Address - Phone:787-824-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist