Provider Demographics
NPI:1962431866
Name:ELLIS, MELISSA KATHLEEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KATHLEEN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MELISSA
Other - Middle Name:KATHLEEN
Other - Last Name:EGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:PHARMACY DEPT 119
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-1050
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:PHARMACY DEPT (119)
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-642-1607
Practice Address - Fax:858-514-1664
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505041835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist