Provider Demographics
NPI:1700158789
Name:ELROD, FELISA SMITH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:FELISA
Middle Name:SMITH
Last Name:ELROD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 GHOLDSTON LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-6500
Mailing Address - Country:US
Mailing Address - Phone:423-775-3500
Mailing Address - Fax:
Practice Address - Street 1:7941 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5924
Practice Address - Country:US
Practice Address - Phone:423-775-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000008004183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist