Individual
MARK ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
10048 CHARLOTTE HWY, INDIAN LAND, SC 29707-7135
(803) 802-1818
Mailing address
10048 CHARLOTTE HWY, INDIAN LAND, SC 29707-7135
(803) 802-1818
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
6745
SC
Other
Enumeration date
01/22/2015
Last updated
01/26/2015
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