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General NPI Number Information
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NPI Number | 1356553812
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Entity Type | Organization
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Legal Business Name | ELLIS PHARMACY
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 468 ELLIS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1928
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Country | US
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Telephone | 415-441-1016
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Fax | 415-441-5088
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Provider Business Mailing Address
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Address Line | 468 ELLIS ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1928
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Country | US
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Telephone | 415-441-1016
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Fax | 415-441-5088
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | MR. HUNG DO PHAM
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Credential | R.PHAR.
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Telephone | 415-441-1016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY31181
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License Number State | CA
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