Scott John Ellis, RPH,CFO

Individual provider Active NPI Pharmacist · Belhaven, NC

NPI 1811149701 · NPPES record last updated Oct 22, 2008

Key facts

NPI
1811149701
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
09024 (NC)
Practice address
892 US Highway 264 Byp
Belhaven, NC 27810-9771
Phone
(252) 943-2585
Fax
(252) 943-3076
NPI assigned
Oct 22, 2008
Sex
Male
Sole proprietor
Yes

Organizations & group practices 2

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.

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

LicenseStateTypeSpecialty
09024NCMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Pungo River Pharmacy Inc Past Accepting new patients
Pungo River Pharmacy Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 09024 NC Yes

Addresses

Primary practice location

892 US Highway 264 Byp
Belhaven, NC 27810-9771

Mailing address

892 US Highway 264 Byp
Belhaven, NC 27810-9771
Phone (252) 943-2585

Other providers in Belhaven, NC

All providers in Belhaven, NC · Pharmacist in North Carolina

Sources for this page

Verify at the official NPI Registry.