Healthcare Provider Details

I. General information

NPI: 1396201430
Provider Name (Legal Business Name): ELLEN SJ OHSIE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 11/18/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

1797 HOLLYBROOK CIR # 6
ANCHORAGE AK
99507-7609
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-2117
  • Fax:
Mailing address:
  • Phone: 213-407-8855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: