Individual
ROSE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
1800 N CALIFORNIA ST, HOME INFUSION PHARMACY, STOCKTON, CA 95204-6019
(209) 461-5486
(209) 461-6890
Mailing address
1200 S SUNSET DR, LODI, CA 95240-5532
(209) 595-7147
(209) 461-6890
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
30597
CA
1835N1003X
Nutrition Support Pharmacist
Primary
30597
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30597
CALIF. LICENSE NUMBER
CA
Enumeration date
11/16/2005
Last updated
09/11/2025
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