Provider Demographics
NPI:1194378570
Name:CLEAVES, ELIZABETH GOODWIN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GOODWIN
Last Name:CLEAVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 MAYFIELD GLEN CV APT 104
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2033
Mailing Address - Country:US
Mailing Address - Phone:901-581-7834
Mailing Address - Fax:
Practice Address - Street 1:7989 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-4007
Practice Address - Country:US
Practice Address - Phone:901-384-0263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN106957967OtherDRIVERS LICENSE