Provider Demographics
NPI:1235343310
Name:JARVIS, ELLEN FASSMANN (RPH PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:FASSMANN
Last Name:JARVIS
Suffix:
Gender:F
Credentials:RPH PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3825
Mailing Address - Country:US
Mailing Address - Phone:801-463-9084
Mailing Address - Fax:
Practice Address - Street 1:2040 S 2300 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-3220
Practice Address - Country:US
Practice Address - Phone:801-487-1018
Practice Address - Fax:801-485-2271
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT145001-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist