Gerald Ellis

Primary specialty

Pharmacotherapy PharmacistTaxonomy code 1835P1200X

License

26023966A Issued in IN

Practice address

10301 E State Road 37
Fort Wayne, IN 46835-9591

Phone

(260) 492-1333

NPI assigned

May 22, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Gerald Ellis Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400716800000",
    "number": "1487066676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6206 TWISTED OAK CT",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468352649",
            "telephone_number": "260-402-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 E STATE ROAD 37",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468359591",
            "telephone_number": "260-492-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "GERALD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-22",
        "last_updated": "2014-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "IN",
            "license": "26023966A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GERALD",
            "last_name": "ELLIS",
            "credential": "R PH",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Brittany L Elliott, BT
• Chad Elliott, DO
• Charlotte Elliott, LCSW
• Gail B Elliott, PT
• Jason Elliott, MA, LMHC
• Isaiah Ellis
• Jaya Ellis
• Jennifer Ellis, ED.S., NCSP
• Sabrina Joline Ellis, DDS
• Logan J. Ellowsky, MSED

• Pharmacotherapy Pharmacist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Pharmacotherapy Pharmacist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2014; 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.