MEDICARE: MR. NORMAN B ELLIS PHARMACIST

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
1	183500000X	Pharmacist		VA

General Provider Information

NPI Number	:	1306069455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NORMAN B ELLIS PHARMACIST

Provider Business Mailing Address
First Line	:	101 FAWN HILLS DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22407-1554
Country	:	US
Telephone Number	:	540-785-8726
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 MCKINNEY BLVD
Second Line	:
City	:	COLONIAL BEACH
State	:	VA
Zip	:	22443-1925
Country	:	US
Telephone Number	:	804-224-2318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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