Healthcare Provider Details

I. General information

NPI: 1548626971
Provider Name (Legal Business Name): SCOTT ELLEFSON RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 W EVERGREEN BLVD
VANCOUVER WA
98660
US

IV. Provider business mailing address

916 W EVERGREEN BLVD
VANCOUVER WA
98660-3035
US

V. Phone/Fax

Practice location:
  • Phone: 360-213-2236
  • Fax:
Mailing address:
  • Phone: 360-213-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0007682
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH-0007682
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: