MEDICARE: MR. ERIC ELLISON SR. PHARMD

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	53369	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932517521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC ELLISON SR. PHARMD

Provider Business Mailing Address
First Line	:	6402 LYONS AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4917
Country	:	US
Telephone Number	:	713-674-6916
Fax Number	:	713-673-3297

Provider Business Practice Location Address
First Line	:	6402 LYONS
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-4917
Country	:	US
Telephone Number	:	713-674-6916
Fax Number	:	713-674-3297

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

Provider Enumeration Date	:	07/26/2014
Last Update Date	:	08/20/2016

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