Provider Demographics
NPI:1427423334
Name:EWELL, CHELSEE NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHELSEE
Middle Name:NICOLE
Last Name:EWELL
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 6966
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-6966
Mailing Address - Country:US
Mailing Address - Phone:909-878-0060
Mailing Address - Fax:909-878-3362
Practice Address - Street 1:42136 BIG BEAR BLVD
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-1530
Practice Address - Country:US
Practice Address - Phone:909-878-0060
Practice Address - Fax:909-878-3362
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73692183500000X
UT84108631701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist