MEDICARE: JUSTUS ELLIS ESQ.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	FE6604878	NC

General Provider Information

NPI Number	:	1881545168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTUS ELLIS ESQ.

Provider Business Mailing Address
First Line	:	1614 GLENRIDGE RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5428
Country	:	US
Telephone Number	:	866-870-9168
Fax Number	:

Provider Business Practice Location Address
First Line	:	1614 GLENRIDGE RD UNIT B
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-5428
Country	:	US
Telephone Number	:	866-870-9168
Fax Number	:

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

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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