Provider Demographics
NPI:1578795456
Name:CROUT, EMILY R (D PH)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:R
Last Name:CROUT
Suffix:
Gender:F
Credentials:D PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16280 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6152
Mailing Address - Country:US
Mailing Address - Phone:901-465-3657
Mailing Address - Fax:
Practice Address - Street 1:16280 HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6152
Practice Address - Country:US
Practice Address - Phone:901-465-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist