Provider Demographics
NPI:1134538291
Name:BERDENNICOVA, ELVIRA (DPH)
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:
Last Name:BERDENNICOVA
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 MORTON MILL CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6717
Mailing Address - Country:US
Mailing Address - Phone:813-394-0749
Mailing Address - Fax:
Practice Address - Street 1:143 MORTON MILL CIR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6717
Practice Address - Country:US
Practice Address - Phone:813-394-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000037085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist