Provider Demographics
NPI:1023188984
Name:BALTZELL, ELLEN DARNELL (PHARM-D)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:DARNELL
Last Name:BALTZELL
Suffix:
Gender:F
Credentials:PHARM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39325-9030
Mailing Address - Country:US
Mailing Address - Phone:601-938-2030
Mailing Address - Fax:
Practice Address - Street 1:5100 HIGHWAY 39 N
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-1023
Practice Address - Country:US
Practice Address - Phone:601-485-0818
Practice Address - Fax:601-485-0534
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist