Provider Demographics
NPI:1730188624
Name:ELLIS, SAMUEL LEE (PHARMD, CDE, BCPS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEE
Last Name:ELLIS
Suffix:
Gender:M
Credentials:PHARMD, CDE, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2083 GLENCOE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80207-3832
Mailing Address - Country:US
Mailing Address - Phone:303-315-1132
Mailing Address - Fax:303-315-4630
Practice Address - Street 1:4200 EAST NINTH AVE
Practice Address - Street 2:C238
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-315-1132
Practice Address - Fax:303-315-4630
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152711835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy