Provider Demographics
NPI:1942593686
Name:WILLIS, ELISABETH ERIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ERIN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11809 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-2707
Mailing Address - Country:US
Mailing Address - Phone:256-974-7663
Mailing Address - Fax:256-905-0320
Practice Address - Street 1:11809 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-2707
Practice Address - Country:US
Practice Address - Phone:256-974-7663
Practice Address - Fax:256-905-0320
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist