Provider Demographics
NPI:1679679427
Name:WEST, MARK ELLIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIS
Last Name:WEST
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 HOPPER BARKER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1827
Mailing Address - Country:US
Mailing Address - Phone:731-664-8633
Mailing Address - Fax:
Practice Address - Street 1:151 HOPPER BARKER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1827
Practice Address - Country:US
Practice Address - Phone:731-664-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6596183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist