Provider Demographics
NPI:1245577055
Name:BELL, MARY ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:BELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:4358 WHITE SURREY DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5135
Mailing Address - Country:US
Mailing Address - Phone:770-419-4049
Mailing Address - Fax:770-419-3973
Practice Address - Street 1:50 BARRETT PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3300
Practice Address - Country:US
Practice Address - Phone:770-419-4049
Practice Address - Fax:770-419-3973
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0135351835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy