Johanna Kristin Ellerup, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

055468 Issued in NY

Practice address

99 N Maple St
North Massapequa, NY 11758-2636

Phone

(516) 509-8185

Fax

(516) 799-8286

NPI assigned

Jun 1, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305158400000",
    "number": "1497957690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 N MAPLE ST",
            "city": "N MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582636",
            "telephone_number": "516-509-8185",
            "fax_number": "516-799-8286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 N MAPLE ST",
            "city": "NORTH MASSAPEQUA",
            "state": "NY",
            "postal_code": "117582636",
            "telephone_number": "516-509-8185",
            "fax_number": "516-799-8286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERUP",
        "first_name": "JOHANNA",
        "middle_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-01",
        "last_updated": "2011-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "079733",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NY",
            "license": "055468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Conway, DPM
• Lauren Dellibovi
• Tina Devlin, LMT
• Michael Joseph Digiovanna, D.O.
• Allison Dreyer, MA CCC-SLP
• Francisco Aquino Espino, M.D.
• Farmingdale Union Free School District
• Maureen Fox, SPED MA
• Francine Fradella, DO
• Paige Frascella

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in North Massapequa, NY
• Providers in North Massapequa, NY by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.

Verify at the official NPI Registry.