MEDICARE: ELLIS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY31181	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356553812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLIS PHARMACY

Provider Business Mailing Address
First Line	:	468 ELLIS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1928
Country	:	US
Telephone Number	:	415-441-1016
Fax Number	:	415-441-5088

Provider Business Practice Location Address
First Line	:	468 ELLIS ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1928
Country	:	US
Telephone Number	:	415-441-1016
Fax Number	:	415-441-5088

Authorized Official
Title or Position	:	PHARMACIST-IN-CHARGE
Name	:	MR. HUNG DO PHAM
Credential	:	R.PHAR.
Telephone Number	:	415-441-1016

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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Directions to “ELLIS PHARMACY ” Practice Location

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