Individual
DR. JUSTIN TODD JELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
400 NE MOTHER JOSEPH PL, VANCOUVER, WA 98664-3200
(360) 514-2061
Mailing address
206 NE 126TH AVE APT G81, VANCOUVER, WA 98684-0889
(360) 773-7508
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00065253
WA
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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