Provider Demographics
NPI:1528409570
Name:ESSENBERG, ELLEN (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ESSENBERG
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 M 66 N
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-9505
Mailing Address - Country:US
Mailing Address - Phone:231-547-0915
Mailing Address - Fax:231-547-5097
Practice Address - Street 1:6600 M 66 N
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-9505
Practice Address - Country:US
Practice Address - Phone:231-547-0915
Practice Address - Fax:231-547-5097
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-07
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist