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General NPI Number Information
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NPI Number | 1760448138
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Entity Type | Individual
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Provider Name | TONYA LEIGH ELLIS PHARMD.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6102 BANKS ST
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City | LULA
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State | GA
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Zip | 30554-2858
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Country | US
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Telephone | 770-869-3616
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Fax | 770-869-9080
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Provider Business Mailing Address
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Address Line | 6675 TWIN MOUNTAIN PT
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City | CLERMONT
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State | GA
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Zip | 30527-1846
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Country | US
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Telephone | 770-983-5758
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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 | RPH020842
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License Number State | GA
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