Provider Demographics
NPI:1083785299
Name:TUBERVILLE, ELIZABETH L
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:TUBERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 OUACHITA 3
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-9206
Mailing Address - Country:US
Mailing Address - Phone:870-837-1370
Mailing Address - Fax:
Practice Address - Street 1:1005 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3828
Practice Address - Country:US
Practice Address - Phone:870-836-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist