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General NPI Number Information
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NPI Number | 1417701061
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Entity Type | Organization
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Legal Business Name | ELLISON MANAGEMENT PLLC
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Dates
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Enumeration Date | 04/11/2024
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 601 HIGHWAY 71 N
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City | MENA
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State | AR
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Zip | 71953-4394
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Country | US
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Telephone | 479-385-9400
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Fax | 479-385-2731
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Provider Business Mailing Address
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Address Line | 601 HIGHWAY 71 N
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City | MENA
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State | AR
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Zip | 71953-4394
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Country | US
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Telephone | 479-385-9400
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Fax | 479-385-2731
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Authorized Official
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Title or Position | PHARMACIST AND OWNER
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Name | LEVI ELLISON
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Credential | PHARMD
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Telephone | 479-385-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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