Healthcare Provider Details

I. General information

NPI: 1326373986
Provider Name (Legal Business Name): LEE ELLERSHAW PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 W PEORIA AVE
PHOENIX AZ
85029-4037
US

IV. Provider business mailing address

500 S 99TH AVE BLDG A
TOLLESON AZ
85353-9700
US

V. Phone/Fax

Practice location:
  • Phone: 602-866-5453
  • Fax: 602-866-5447
Mailing address:
  • Phone: 623-907-4932
  • Fax: 623-907-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13784
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: