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General NPI Number Information
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NPI Number | 1053452193
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Entity Type | Individual
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Provider Name | ELIZABETH MARY SEGRAVES PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11424 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37934-3915
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Country | US
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Telephone | 865-966-9728
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Fax | 865-671-1981
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Provider Business Mailing Address
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Address Line | 10932 THORNTON DR
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City | KNOXVILLE
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State | TN
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Zip | 37934-2922
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Country | US
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Telephone | 865-675-1405
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Fax | 865-671-1981
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7935
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License Number State | TN
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