Provider Demographics
NPI:1902336134
Name:STURGILL, MARK ELLIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ELLIS
Last Name:STURGILL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 SADDLERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2507
Mailing Address - Country:US
Mailing Address - Phone:804-364-0243
Mailing Address - Fax:
Practice Address - Street 1:11895 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-1065
Practice Address - Country:US
Practice Address - Phone:804-360-3268
Practice Address - Fax:804-360-3848
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist