Provider Demographics
NPI:1801666797
Name:KRUSE, ELLEN ASHLEY (PHARMD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ASHLEY
Last Name:KRUSE
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 1:2200 BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5000
Mailing Address - Country:US
Mailing Address - Phone:979-776-6441
Mailing Address - Fax:
Practice Address - Street 1:2200 BRIARCREST DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5000
Practice Address - Country:US
Practice Address - Phone:979-776-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72604183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist