Provider Demographics
NPI:1215096987
Name:SCHULZ, ELLEN PATRICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:PATRICIA
Last Name:SCHULZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-1481
Mailing Address - Country:US
Mailing Address - Phone:208-788-9644
Mailing Address - Fax:208-726-8268
Practice Address - Street 1:451 4TH ST
Practice Address - Street 2:
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-2596
Practice Address - Fax:208-726-8268
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist