Provider Demographics
NPI:1306069455
Name:ELLIS, NORMAN B (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:B
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FAWN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1554
Mailing Address - Country:US
Mailing Address - Phone:540-785-8726
Mailing Address - Fax:
Practice Address - Street 1:700 MCKINNEY BLVD
Practice Address - Street 2:
Practice Address - City:COLONIAL BEACH
Practice Address - State:VA
Practice Address - Zip Code:22443-1925
Practice Address - Country:US
Practice Address - Phone:804-224-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist