Provider Demographics
NPI:1780204206
Name:EBWELLESON, INES NZELLE NSONLI (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:INES
Middle Name:NZELLE NSONLI
Last Name:EBWELLESON
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 1:10 SANTA CLARITA CIR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3352
Mailing Address - Country:US
Mailing Address - Phone:832-774-1350
Mailing Address - Fax:
Practice Address - Street 1:10 SANTA CLARITA CIR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3352
Practice Address - Country:US
Practice Address - Phone:832-774-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist