Provider Demographics
NPI:1346430899
Name:MAXWELL, ELLEN (PHARMD, BCACP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6737 W WASHINGTON ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5653
Mailing Address - Country:US
Mailing Address - Phone:414-337-3333
Mailing Address - Fax:414-337-3338
Practice Address - Street 1:6737 W WASHINGTON ST STE 1100
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5653
Practice Address - Country:US
Practice Address - Phone:414-337-3333
Practice Address - Fax:414-337-3338
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20622183500000X
WI15166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist