Provider Demographics
NPI:1922646900
Name:ELLIOTT, STANLEY CRAIG
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:CRAIG
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-1702
Mailing Address - Country:US
Mailing Address - Phone:901-476-1798
Mailing Address - Fax:901-476-1799
Practice Address - Street 1:951 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-1702
Practice Address - Country:US
Practice Address - Phone:901-476-1798
Practice Address - Fax:901-476-1799
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80621835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist