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General NPI Number Information
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NPI Number | 1508466509
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Entity Type | Individual
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Provider Name | DR. TIMOTHY JOSEPH ELLERMAN II
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Gender | Male
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 2251 E STATE HIGHWAY 54
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City | LINTON
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State | IN
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Zip | 47441-9498
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Country | US
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Telephone | 812-847-8648
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Fax | 812-824-4353
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Provider Business Mailing Address
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Address Line | 7639 S CHIMNEY PIER RD
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City | VINCENNES
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State | IN
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Zip | 47591-7383
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Country | US
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Telephone | 812-890-5301
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26021422A
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License Number State | IN
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