Individual
JUSTIN JAMES ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1625 N 44TH ST, PHOENIX, AZ 85008-4114
(602) 275-0120
Mailing address
1625 N 44TH ST, PHOENIX, AZ 85008-4114
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S023901
AZ
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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