Provider Demographics
NPI:1124906169
Name:ELLENBERG, MEGAN TAYLOR (BS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:TAYLOR
Last Name:ELLENBERG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:TAYLOR
Other - Last Name:ELLENBURG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:219 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45345-1322
Mailing Address - Country:US
Mailing Address - Phone:937-313-5487
Mailing Address - Fax:
Practice Address - Street 1:402 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-6099
Practice Address - Country:US
Practice Address - Phone:937-313-5487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060002707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist