Provider Demographics
NPI:1538347901
Name:ELLIS, CYNTHIA K (RPH)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BEL AIR SOUTH PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6091
Mailing Address - Country:US
Mailing Address - Phone:443-512-8373
Mailing Address - Fax:443-512-8379
Practice Address - Street 1:5 BEL AIR SOUTH PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6091
Practice Address - Country:US
Practice Address - Phone:443-512-8373
Practice Address - Fax:443-512-8379
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist