Provider Demographics
NPI:1932491933
Name:ELLEFSON, JON LEONARD
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:LEONARD
Last Name:ELLEFSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 N TEGNER RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-9401
Mailing Address - Country:US
Mailing Address - Phone:209-656-5328
Mailing Address - Fax:209-656-5325
Practice Address - Street 1:2955 N TEGNER RD
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-9401
Practice Address - Country:US
Practice Address - Phone:209-656-5328
Practice Address - Fax:209-656-5325
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist