Jeffry Richard Ellis, R.PH.
Individual provider Active NPI Pharmacist · Sandwich, IL
NPI 1699716845 · NPPES record last updated Dec 7, 2009
Key facts
- NPI
- 1699716845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.030682 (IL)
- Practice address
- 142 Indian Springs Dr
Sandwich, IL 60548-1902 - Phone
- (815) 786-2300
- Fax
- (815) 786-2311
- NPI assigned
- Jun 9, 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 |
|---|---|---|---|
| 051.030682 | IL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051.030682 | IL | Yes |
Addresses
Primary practice location
142 Indian Springs Dr
Sandwich, IL 60548-1902
Mailing address
1175 Lady Bird Dr
Somonauk, IL 60552-9627
Other providers in Sandwich, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 7, 2009. 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.