Healthcare Provider Details

I. General information

NPI: 1629387378
Provider Name (Legal Business Name): STEPHEN DAVID ELLWOOD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP CARL R. DARNALL ARMY MEDICAL CENTER
FORT HOOD TX
76544
US

IV. Provider business mailing address

643 VIA FIRENZE
CATHEDRAL CITY CA
92234-4184
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8025
  • Fax: 254-286-7326
Mailing address:
  • Phone: 707-206-8172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: