Provider Demographics
NPI:1396035838
Name:CRENSHAW, ANETHA CHANTEL (PT, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANETHA
Middle Name:CHANTEL
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:PT, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8211
Mailing Address - Country:US
Mailing Address - Phone:901-624-5720
Mailing Address - Fax:
Practice Address - Street 1:6500 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8211
Practice Address - Country:US
Practice Address - Phone:901-624-5720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33730183500000X
MSE-010577183500000X
TN6316251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No251E00000XAgenciesHome Health