Provider Demographics
NPI:1912471384
Name:MCCORMICK, ELLEN ALGEE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ALGEE
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-3915
Mailing Address - Country:US
Mailing Address - Phone:662-622-7441
Mailing Address - Fax:662-622-7004
Practice Address - Street 1:421 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-3915
Practice Address - Country:US
Practice Address - Phone:662-622-7441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-8165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist