Provider Demographics
NPI:1649577214
Name:CATHEY, ELYSICA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELYSICA
Middle Name:L
Last Name:CATHEY
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 1:3324 JEFF BROWNING BLVD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7303
Mailing Address - Country:US
Mailing Address - Phone:901-545-7614
Mailing Address - Fax:901-545-8884
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-545-7614
Practice Address - Fax:901-545-8884
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist