Healthcare Provider Details

I. General information

NPI: 1932340544
Provider Name (Legal Business Name): ROBYN ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N OWEN WALTERS BLVD
SALINA OK
74365-5003
US

IV. Provider business mailing address

900 N OWEN WALTERS BLVD
SALINA OK
74365-5003
US

V. Phone/Fax

Practice location:
  • Phone: 918-434-8500
  • Fax: 918-434-9587
Mailing address:
  • Phone: 918-434-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11844
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8395
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: