Jessica Dyanne Ellis

NPI #1659976546 in Locust Grove, Oklahoma

Provider Information

NPI Number: 1659976546
Entity Type: Individual
Name: Jessica Dyanne Ellis
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Pharmacist
Enumeration Date: Dec 1, 2020
Last Updated: Dec 1, 2020

Practice Location

Address: 800 E MAIN ST
City: Locust Grove
State: Oklahoma
ZIP Code: 74352-5184
Phone: (918) 479-4815

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacist	183500000X	Primary

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