Provider Demographics
NPI:1447283403
Name:OESTRIKE, ELAINE ANN
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ANN
Last Name:OESTRIKE
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 1:121 W PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-1258
Mailing Address - Country:US
Mailing Address - Phone:269-649-0660
Mailing Address - Fax:
Practice Address - Street 1:121 W PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MI
Practice Address - Zip Code:49097-1258
Practice Address - Country:US
Practice Address - Phone:269-649-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist