Provider Demographics
NPI:1659629673
Name:ELLIS, BRITTANY WATTS (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:WATTS
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2518
Mailing Address - Country:US
Mailing Address - Phone:843-423-1021
Mailing Address - Fax:843-423-2178
Practice Address - Street 1:700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2518
Practice Address - Country:US
Practice Address - Phone:843-423-1021
Practice Address - Fax:843-423-2178
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist