MEDICARE: TODD ELLSWORTH RPH

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	36766	TX

General Provider Information

NPI Number	:	1437476256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD ELLSWORTH RPH

Provider Business Mailing Address
First Line	:	500 CANYON RIDGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-1632
Country	:	US
Telephone Number	:	512-973-8753
Fax Number	:	512-973-9697

Provider Business Practice Location Address
First Line	:	500 CANYON RIDGE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78753-1632
Country	:	US
Telephone Number	:	512-973-8753
Fax Number	:	512-973-9697

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

Provider Enumeration Date	:	05/04/2010
Last Update Date	:	05/04/2010

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