Provider Demographics
NPI:1477172179
Name:ELY, JAMES MORGAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MORGAN
Last Name:ELY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-9203
Mailing Address - Country:US
Mailing Address - Phone:405-207-7729
Mailing Address - Fax:
Practice Address - Street 1:100 E I 240 SERVICE RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-1612
Practice Address - Country:US
Practice Address - Phone:405-631-2207
Practice Address - Fax:405-631-2230
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist