Provider Demographics
NPI:1144581596
Name:ELLISON, RUTH ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ELLEN
Last Name:ELLISON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-8431
Mailing Address - Country:US
Mailing Address - Phone:620-663-2241
Mailing Address - Fax:620-664-6341
Practice Address - Street 1:510 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-8431
Practice Address - Country:US
Practice Address - Phone:620-663-2241
Practice Address - Fax:620-664-6341
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-13765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-13765OtherKS PHARMACIST LICENSE