Individual
JESSICA DYANNE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
800 E MAIN ST, LOCUST GROVE, OK 74352-5184
(918) 479-4815
(918) 479-4817
Mailing address
800 E MAIN ST, LOCUST GROVE, OK 74352-5184
(918) 479-4815
(918) 479-4817
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15269
OK
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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