MEDICARE: ELLECIA BERNARD PHARM.D.

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	183500000X	Pharmacist	5302045583	MI

General Provider Information

NPI Number	:	1841816295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLECIA BERNARD PHARM.D.

Provider Business Mailing Address
First Line	:	24900 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-4769
Country	:	US
Telephone Number	:	586-774-3385
Fax Number	:

Provider Business Practice Location Address
First Line	:	24900 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-4769
Country	:	US
Telephone Number	:	586-774-3385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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