Provider Demographics
NPI:1598377723
Name:ELLISON, LEVI (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:ELLISON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 71 N
Mailing Address - Street 2:
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-4394
Mailing Address - Country:US
Mailing Address - Phone:479-385-9400
Mailing Address - Fax:479-385-2731
Practice Address - Street 1:601 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-4394
Practice Address - Country:US
Practice Address - Phone:479-385-9400
Practice Address - Fax:479-385-2731
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist