Charles Ray Ellexson, RPH
Individual provider Active NPI Pharmacist · Bonham, TX
NPI 1619086709 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1619086709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28257 (TX)
- Practice address
- 1201 E 9TH St
Bonham, TX 75418-4059 - Phone
- (903) 583-6787
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8283 | OK | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 8283 | OK | |
| Pharmacist | 183500000X | 28257 | TX | Yes |
Addresses
Primary practice location
1201 E 9TH St
Bonham, TX 75418-4059
Mailing address
4774 Old Highway 70
Durant, OK 74701-0704
Phone (580) 924-4549
Other providers in Bonham, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.