Provider Demographics
NPI:1518116300
Name:LUSE, ELLEN N (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:N
Last Name:LUSE
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 1:323 HICKORY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-6252
Mailing Address - Country:US
Mailing Address - Phone:706-889-3499
Mailing Address - Fax:
Practice Address - Street 1:323 HICKORY RIDGE DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-6252
Practice Address - Country:US
Practice Address - Phone:706-889-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist