Healthcare Provider Details

I. General information

NPI: 1093301731
Provider Name (Legal Business Name): EBELL HSIEH PHARM D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NE 20TH ST
NEWPORT OR
97365-1851
US

IV. Provider business mailing address

200 NECTARINE DR
NEWNAN GA
30265-1606
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-1733
  • Fax: 541-272-3301
Mailing address:
  • Phone: 626-675-3174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number024409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: