Provider Demographics
NPI:1023227832
Name:CARMICHAEL, JR., ELLIS PRESTON (RPH)
Entity type:Individual
Prefix:MR
First Name:ELLIS
Middle Name:PRESTON
Last Name:CARMICHAEL, JR.
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 PINE BRK
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4188
Mailing Address - Country:US
Mailing Address - Phone:281-290-8084
Mailing Address - Fax:281-351-7707
Practice Address - Street 1:1010 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-5526
Practice Address - Country:US
Practice Address - Phone:281-351-5454
Practice Address - Fax:281-351-7707
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17860183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist