Provider Demographics
NPI:1407316771
Name:ELLEFSON, LISA DANIELLE (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DANIELLE
Last Name:ELLEFSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 HASSAN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-2524
Mailing Address - Country:US
Mailing Address - Phone:320-587-2509
Mailing Address - Fax:320-587-0283
Practice Address - Street 1:237 HASSAN ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-2524
Practice Address - Country:US
Practice Address - Phone:320-587-2509
Practice Address - Fax:320-587-0283
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist