Provider Demographics
NPI:1043075062
Name:BECKER-ELLISON, DAVID C (RPH)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BECKER-ELLISON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CALLANDER WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6101
Mailing Address - Country:US
Mailing Address - Phone:916-200-5162
Mailing Address - Fax:
Practice Address - Street 1:3964 MISSOURI FLAT RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5238
Practice Address - Country:US
Practice Address - Phone:530-626-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45407183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist