Healthcare Provider Details

I. General information

NPI: 1568303659
Provider Name (Legal Business Name): GENELLE P ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALKER BUILDING 2316, 362 THACH CONCOURSE
AUBURN AL
36849-0001
US

IV. Provider business mailing address

4315 GOLF CLUB DR APT 304
AUBURN AL
36830-5839
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-8348
  • Fax:
Mailing address:
  • Phone: 559-287-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: