Provider Demographics
NPI:1760603617
Name:EALY, ELIZABETH SUE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SUE
Last Name:EALY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 APPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745
Mailing Address - Country:US
Mailing Address - Phone:423-639-0456
Mailing Address - Fax:
Practice Address - Street 1:905 SNAPPS FERRY ROAD
Practice Address - Street 2:FOOD CITY PHARMACY #606
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745
Practice Address - Country:US
Practice Address - Phone:423-638-8689
Practice Address - Fax:423-638-6325
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist