Basic Information
| Provider Information | |||||||||
| NPI: | 1366684029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELWAN | ||||||||
| FirstName: | AKRAM | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | ELWAN | ||||||||
| OtherFirstName: | AKRAM | ||||||||
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| OtherCredential: | PHARM D | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 LEANING TREE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292233007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037082753 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6439 GARNERS FERRY ROAD | ||||||||
| Address2: | WM. JENNINGS DORN MEDICAL CENTER | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 03/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 011110 | SC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.