Provider Demographics
NPI:1689707226
Name:PHILLIPS, ELLEN ADELE (PHARM D)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ADELE
Last Name:PHILLIPS
Suffix:
Gender:F
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 1:717 DAWSON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9007
Mailing Address - Country:US
Mailing Address - Phone:865-692-1805
Mailing Address - Fax:865-692-4246
Practice Address - Street 1:5941 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6344
Practice Address - Country:US
Practice Address - Phone:865-588-0972
Practice Address - Fax:865-588-6242
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist