Individual
JASON TED ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
500 11TH ST SW, SPENCER, IA 51301-5826
(712) 262-5011
(712) 262-5469
Mailing address
1503 W 13TH ST, SPENCER, IA 51301-2925
(712) 260-6120
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18437
IA
Other
Enumeration date
04/11/2019
Last updated
04/11/2019
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