Healthcare Provider Details

I. General information

NPI: 1083341366
Provider Name (Legal Business Name): ELLA COMMUNITY PHARMACY 1, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 JERSEY ST
WESTFIELD IN
46074-9187
US

IV. Provider business mailing address

20505 FREEMONT MOORE RD
SHERIDAN IN
46069-9155
US

V. Phone/Fax

Practice location:
  • Phone: 317-896-9378
  • Fax: 317-896-2731
Mailing address:
  • Phone: 317-896-9378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIK ANGELOTTI
Title or Position: OWNER
Credential: PHARMD, RPH
Phone: 317-896-9378