Provider Demographics
NPI:1992917470
Name:ELLIS, JUDITH BELINDA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:BELINDA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 KENSINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803
Mailing Address - Country:US
Mailing Address - Phone:865-982-4975
Mailing Address - Fax:
Practice Address - Street 1:129 GILL ST
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701
Practice Address - Country:US
Practice Address - Phone:865-984-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist