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General NPI Number Information
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NPI Number | 1801902317
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Entity Type | Individual
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Provider Name | JODY ELLINGSON PHARM.D
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/23/2007
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Provider Practice Location Address
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Address Line | 49725 COUNTY 83
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City | STAPLES
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State | MN
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Zip | 56479-5280
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Country | US
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Telephone | 218-894-8761
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Fax | 218-897-8761
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Provider Business Mailing Address
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Address Line | 26564 315TH AVE
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City | LONG PRAIRIE
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State | MN
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Zip | 56347-4653
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Country | US
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Telephone | 218-894-8761
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Fax | 218-894-8762
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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 | 5451
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License Number State | SD
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