MEDICARE: MRS. ELIZABETH WILSON TRUELOVE R.PH.

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	8816	TN

General Provider Information

NPI Number	:	1710051339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH WILSON TRUELOVE R.PH.

Provider Business Mailing Address
First Line	:	610 STALANS DR
Second Line	:
City	:	ETOWAH
State	:	TN
Zip	:	37331-1067
Country	:	US
Telephone Number	:	423-887-7293
Fax Number	:	423-887-7022

Provider Business Practice Location Address
First Line	:	18 CHURCH ST
Second Line	:
City	:	ENGLEWOOD
State	:	TN
Zip	:	37329-3301
Country	:	US
Telephone Number	:	423-887-7293
Fax Number	:	423-887-7022

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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