Provider Demographics
NPI:1457961203
Name:CURTIS, ELLA MAE
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:MAE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 MELONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2732
Mailing Address - Country:US
Mailing Address - Phone:727-799-7760
Mailing Address - Fax:
Practice Address - Street 1:11001 ROOSEVELT BLVD N STE 1400
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-2338
Practice Address - Country:US
Practice Address - Phone:866-448-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist