Provider Demographics
NPI:1487943015
Name:ELLIS, STEPHANIE ROBIN (PHARMD)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ROBIN
Last Name:ELLIS
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 1:2339 NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37876-2057
Mailing Address - Country:US
Mailing Address - Phone:865-908-8695
Mailing Address - Fax:865-908-8774
Practice Address - Street 1:2339 NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37876-2057
Practice Address - Country:US
Practice Address - Phone:865-908-8695
Practice Address - Fax:865-908-8774
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006507183500000X, 183500000X
TN0000012398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist