Provider Demographics
NPI:1477937902
Name:MAX, ELLINA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELLINA
Middle Name:K
Last Name:MAX
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 1:300 MEADOWMONT VILLAGE CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7518
Mailing Address - Country:US
Mailing Address - Phone:984-974-7244
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOWMONT VILLAGE CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-7518
Practice Address - Country:US
Practice Address - Phone:984-974-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215311835P0018X, 1835P1200X, 261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care