Provider Demographics
NPI:1952564254
Name:ELLIOTT, BEVERLY W (DPH)
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:W
Last Name:ELLIOTT
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 1:2525 DE SALES AVE
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404
Mailing Address - Country:US
Mailing Address - Phone:423-495-8380
Mailing Address - Fax:423-495-7719
Practice Address - Street 1:2525 DE SALES AVE
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-495-8380
Practice Address - Fax:423-495-7719
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist