Provider Demographics
NPI:1164722633
Name:ROSSER, ELIZABETH A
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:ROSSER
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 1:116 ROBERTSON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068
Mailing Address - Country:US
Mailing Address - Phone:901-465-9892
Mailing Address - Fax:901-465-3057
Practice Address - Street 1:116 ROBERTSON DR
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1912
Practice Address - Country:US
Practice Address - Phone:901-465-9892
Practice Address - Fax:901-465-3057
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6029183500000X
TN6742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist