Healthcare Provider Details

I. General information

NPI: 1457491565
Provider Name (Legal Business Name): CHRISTOPHER WINSTON ELLISON PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE NW BLDG 2 RM 2P02
WASHINGTON DC
20307-0003
US

IV. Provider business mailing address

8100 HIGHWAY 377
BLANKET TX
76432-6354
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6224
  • Fax:
Mailing address:
  • Phone: 469-337-7666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: