Active NPI
Brian Eric Ellis, RPH
- Pharmacist
- Bel Air, MD
National Provider Identifier
1194010090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 11755
- Practice address
- 580 Marketplace Dr
T-1002
Bel Air, MD 21014-4310 - Phone
- (410) 638-9031
- Fax
- (410) 638-9031
- NPI assigned
- Jun 20, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 11755 | MD | Primary |
Addresses
Primary practice location
580 Marketplace Dr
T-1002
Bel Air, MD 21014-4310
Mailing address
580 Marketplace Dr
T-1002
Bel Air, MD 21014-4310
Phone (410) 638-9031
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11755 | MD | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1308528000000",
"number": "1194010090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 MARKETPLACE DR",
"address_2": "T-1002",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210144310",
"telephone_number": "410-638-9031",
"fax_number": "410-638-9031"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 MARKETPLACE DR",
"address_2": "T-1002",
"city": "BEL AIR",
"state": "MD",
"postal_code": "210144310",
"telephone_number": "410-638-9031",
"fax_number": "410-638-9031"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "BRIAN",
"middle_name": "ERIC",
"name_prefix": "Mr.",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-20",
"last_updated": "2011-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MD",
"license": "11755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bel Air, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.