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NPI Code Detail

MEDICARE: JUSTIN JAMES ELLIS

MEDICARE: JUSTIN JAMES ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistS023901AZ

General Provider Information

NPI Number : 1275181836
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN JAMES ELLIS
Provider Business Mailing Address
First Line : 1625 N 44TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4114
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1625 N 44TH ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-4114
Country : US
Telephone Number : 602-275-0120
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2019
Last Update Date : 08/27/2019

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Directions to “ JUSTIN JAMES ELLIS ” Practice Location

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