MEDICARE: DR. ELIZABETH DEAVER CRONAN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH033066	GA

General Provider Information

NPI Number	:	1225705213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH DEAVER CRONAN PHARMD

Provider Business Mailing Address
First Line	:	PO BOX 1399
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30015-1399
Country	:	US
Telephone Number	:	706-318-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 SIBLEY AVE
Second Line	:
City	:	UNION POINT
State	:	GA
Zip	:	30669-1140
Country	:	US
Telephone Number	:	706-486-2131
Fax Number	:	706-486-2132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2021
Last Update Date	:	08/26/2021

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