Provider Demographics
NPI:1699036467
Name:ELLISON, BRIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:ELLISON
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 1:1532 BRADEN OVERLOOK CT
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4328
Mailing Address - Country:US
Mailing Address - Phone:252-996-0073
Mailing Address - Fax:
Practice Address - Street 1:401 GLENWOOD AVE # 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-856-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist