Provider Demographics
NPI:1902041486
Name:BLACKWELL, ELIZABETH STEVENS
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STEVENS
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROXBORO RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2642
Mailing Address - Country:US
Mailing Address - Phone:919-693-8555
Mailing Address - Fax:919-603-0214
Practice Address - Street 1:140 ROXBORO RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2642
Practice Address - Country:US
Practice Address - Phone:919-693-8555
Practice Address - Fax:919-603-0214
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist