Active NPI
Cory Scott Ellerbrock, PHARMD, RPH
- Pharmacist
- Defiance, OH
National Provider Identifier
1891146254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 03135776-1
- Practice address
- 1816 E 2ND St
Defiance, OH 43512-2502 - Phone
- (419) 782-7832
- NPI assigned
- Jun 28, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 03135776-1 | OH | Primary |
Addresses
Primary practice location
1816 E 2ND St
Defiance, OH 43512-2502
Mailing address
195 Eastowne Dr
Ottawa, OH 45875-8719
Phone (419) 890-6830
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03135776-1 | OH | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lane Drug Co | Past | Accepting new patients | |
| Lane Drug Co | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467072000000",
"number": "1891146254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "195 EASTOWNE DR",
"city": "OTTAWA",
"state": "OH",
"postal_code": "458758719",
"telephone_number": "419-890-6830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1816 E 2ND ST",
"city": "DEFIANCE",
"state": "OH",
"postal_code": "435122502",
"telephone_number": "419-782-7832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLERBROCK",
"first_name": "CORY",
"middle_name": "SCOTT",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-28",
"last_updated": "2016-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OH",
"license": "03135776-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Defiance, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.