Provider Demographics
NPI:1578275236
Name:ELLIS, JENNIFER MONSOD (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MONSOD
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4574 N HIATUS RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7987
Mailing Address - Country:US
Mailing Address - Phone:877-367-3479
Mailing Address - Fax:
Practice Address - Street 1:4574 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7987
Practice Address - Country:US
Practice Address - Phone:877-367-3479
Practice Address - Fax:833-347-9329
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist