Provider Demographics
NPI:1508099458
Name:EZZELLE, JEFFREY H (RPH)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:H
Last Name:EZZELLE
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 1:7917 E OAK ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8062
Mailing Address - Country:US
Mailing Address - Phone:910-278-6050
Mailing Address - Fax:910-278-6024
Practice Address - Street 1:7917 E OAK ISLAND DR
Practice Address - Street 2:
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8062
Practice Address - Country:US
Practice Address - Phone:910-278-6050
Practice Address - Fax:910-278-6024
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist