Jana Leigh Ellis IX

Primary specialty

PharmacistTaxonomy code 183500000X

License

PD10867 Issued in AR

Practice address

5210 Oaklawn Blvd
North Prince George, VA 23860-7336

Phone

(804) 458-8688

NPI assigned

Apr 29, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Rite Aid of Virginia Inc

  • Community/Retail Pharmacy
  • Hopewell, VA
  • NPI 1114036415
  NPD (past)
• Rite Aid of Virginia Inc

  • Community/Retail Pharmacy
  • Grottoes, VA
  • NPI 1982319000
  NPD (past)

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

{
    "created_epoch": "1651190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1487399895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13005 CHIPSTEAD RD",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238314664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5210 OAKLAWN BLVD",
            "city": "NORTH PRINCE GEORGE",
            "state": "VA",
            "postal_code": "238607336",
            "telephone_number": "804-458-8688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JANA",
        "middle_name": "LEIGH",
        "name_suffix": "IX",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-29",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "VA",
            "license": "0202216556",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "AR",
            "license": "PD10867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "0202216556",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "PD10867",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annointed Hands LLC
• Frances Antonio
• Controlled Outcomes
• Andrew Edmonds
• FCC Petersburg
• Follow Your Heart
• Chris Gollub
• Sangok Gollub
• Anjelica Dee Harris, LMT

• Pharmacist in North Prince George, VA
• Providers in North Prince George, VA by specialty
• Pharmacist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.