Provider Demographics
NPI:1528051497
Name:OWANS, ELLEN B
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:B
Last Name:OWANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FIVE IRON CIR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3151
Mailing Address - Country:US
Mailing Address - Phone:843-875-0827
Mailing Address - Fax:
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6008
Practice Address - Country:US
Practice Address - Phone:843-873-2531
Practice Address - Fax:843-873-4572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13179183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician