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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
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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