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NPI Code Detail

MEDICARE: MARK ELLIS STURGILL PHARM D

MEDICARE: MARK ELLIS STURGILL PHARM D
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
1183500000XPharmacist0202206662VA

General Provider Information

NPI Number : 1902336134
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ELLIS STURGILL PHARM D
Provider Business Mailing Address
First Line : 4813 SADDLERIDGE CT
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23059-2507
Country : US
Telephone Number : 804-364-0243
Fax Number :
Provider Business Practice Location Address
First Line : 11895 W BROAD ST
Second Line :
City : HENRICO
State : VA
Zip : 23233-1065
Country : US
Telephone Number : 804-360-3268
Fax Number : 804-360-3848
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2017
Last Update Date : 06/16/2018

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