Provider Demographics
NPI:1982256657
Name:ELLINGER, MEAGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:
Last Name:ELLINGER
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 1:2030 HETRICK RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:IN
Mailing Address - Zip Code:47010-9705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2030 HETRICK RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:IN
Practice Address - Zip Code:47010-9705
Practice Address - Country:US
Practice Address - Phone:765-580-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028183A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist