Provider Demographics
NPI:1164946547
Name:ELLISON, LINDSEY JEAN
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JEAN
Last Name:ELLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 HIGHWAY 72 W
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9559
Mailing Address - Country:US
Mailing Address - Phone:256-895-9326
Mailing Address - Fax:256-895-9879
Practice Address - Street 1:7813 HIGHWAY 72 W
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9559
Practice Address - Country:US
Practice Address - Phone:256-895-9326
Practice Address - Fax:256-895-9879
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19954183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist