Basic Information
| Provider Information | |||||||||
| NPI: | 1578883898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWERS | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4103 CEDAR POINT RD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380023969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049139841 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4642 QUINCE RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381176547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9016859368 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 06/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 25919 | TN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.