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NPI Code Detail

MEDICARE: MRS. SANDRA ELLIS RPH

MEDICARE: MRS. SANDRA ELLIS 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
1183500000XPharmacist042672MO

General Provider Information

NPI Number : 1952683906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SANDRA ELLIS RPH
Provider Business Mailing Address
First Line : 3004 POST MEADOWS CT
Second Line :
City : O FALLON
State : MO
Zip : 63368-7046
Country : US
Telephone Number : 636-561-8234
Fax Number :
Provider Business Practice Location Address
First Line : 530 MID RIVERS MALL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2150
Country : US
Telephone Number : 636-970-3222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2011
Last Update Date : 09/15/2011

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Directions to “ MRS. SANDRA ELLIS RPH” Practice Location

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