Individual
MS. MARY MARGARET ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
1490 MEXICO LOOP RD E, O FALLON, MO 63366-6015
(636) 978-1602
Mailing address
400 MASON RIDGE DR, SAINT CHARLES, MO 63304-7283
(636) 447-5977
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
042428
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922013176
—
MO
Enumeration date
09/24/2011
Last updated
09/24/2011
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