Healthcare Provider Details

I. General information

NPI: 1588987341
Provider Name (Legal Business Name): ELLENA AN LUNN MAR PHARMD, APH, BCACP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 QUARRY RD RM 2726A
PALO ALTO CA
94304-1416
US

IV. Provider business mailing address

213 QUARRY RD RM 2726A
PALO ALTO CA
94304-1416
US

V. Phone/Fax

Practice location:
  • Phone: 650-721-5126
  • Fax:
Mailing address:
  • Phone: 650-721-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number63120
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number63120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: