Provider Demographics
NPI:1568555787
Name:SEWELL, ELIZABETH MARIE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARIE
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6721 WASHINGTON AVE APT 32I
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2177
Mailing Address - Country:US
Mailing Address - Phone:501-690-3053
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST AND KEESLER MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-4955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist