Provider Demographics
NPI:1346846326
Name:ELLISON, CATHERINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ELLISON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 HANNA RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8534
Mailing Address - Country:US
Mailing Address - Phone:216-471-7738
Mailing Address - Fax:
Practice Address - Street 1:1145 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3327
Practice Address - Country:US
Practice Address - Phone:330-298-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03338148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist