Provider Demographics
NPI:1164707675
Name:DEXTER, ELLEN (RPH (PHARMACIST))
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:DEXTER
Suffix:
Gender:F
Credentials:RPH (PHARMACIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 PROVIDENCE HIGHWAY
Mailing Address - Street 2:WALGREENS CO.
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-762-1561
Mailing Address - Fax:781-762-8343
Practice Address - Street 1:39 FLINT LOCKE LN
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1914
Practice Address - Country:US
Practice Address - Phone:781-762-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-15
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist