Provider Demographics
NPI:1477187003
Name:ELLIS, JOEL HARRISON (RPH)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:HARRISON
Last Name:ELLIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607A BOLL WEEVIL CIR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2733
Mailing Address - Country:US
Mailing Address - Phone:334-347-4242
Mailing Address - Fax:
Practice Address - Street 1:607A BOLL WEEVIL CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2733
Practice Address - Country:US
Practice Address - Phone:334-347-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist