MEDICARE: COURTNEY ELLIS RPH, PHARMD, MBA

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	1835P1200X	Pharmacotherapy Pharmacist	45151	TN

General Provider Information

NPI Number	:	1548833031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ELLIS RPH, PHARMD, MBA

Provider Business Mailing Address
First Line	:	4124 BRANDYWINE POINTE BLVD
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-1936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 INTERNATIONAL PLZ
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-2017
Country	:	US
Telephone Number	:	615-367-8843
Fax Number	:

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

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	03/01/2024

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