Clarence Peacock Ellison Jr.

Primary specialty

PharmacistTaxonomy code 183500000X

License

10902 Issued in NC

Practice address

1103 Wayne Memorial Dr
Goldsboro, NC 27534-2957

Phone

(919) 735-0400

Fax

(919) 735-3530

NPI assigned

Jun 12, 2023

Last updated

Jun 12, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coor's Pharmacy, Inc

  • Community/Retail Pharmacy
  • Goldsboro, NC
  • NPI 1427081439
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1245914357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342957",
            "telephone_number": "919-735-0400",
            "fax_number": "919-735-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 WAYNE MEMORIAL DR",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275342957",
            "telephone_number": "919-735-0400",
            "fax_number": "919-735-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "CLARENCE",
        "middle_name": "PEACOCK",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "10902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elijah Home Care
• Elite Care Inc
• Jaclyn Ashley Elliott, PA-C
• Jerome L Ellis
• Sarah Ellis
• Jasmine Detrice Ellison, LCSW-A
• Elysium Counseling, PLLC
• Embrace Life Home Care of NC, LLC
• Emeritus Corporation (Brookdale Country Day Road)
• Emily Daniel DDS PLLC

• Pharmacist in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Pharmacist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.