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Organization
ELLISVILLE STATE SCHOOL
Active
Organization
ELLISVILLE STATE SCHOOL
Active
Other names
ELLISVILLE STATE SCHOOL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI WELCH RPH (PHCY DIR)
(601) 477-5784
Entity
Organization
Contact information
Practice address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5785
(601) 477-5687
Mailing address
1101 HIGHWAY 11 S, ELLISVILLE, MS 39437-4443
(601) 477-5785
(601) 477-5687
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
01185031
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030384
—
MS
01
—
2050712
PK
—
Enumeration date
09/13/2006
Last updated
12/17/2019
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