1710051339 NPI number — MRS. ELIZABETH WILSON TRUELOVE R.PH.

Table of content: DR. ALEKSANDR MERENKOV PHARM D (NPI 1063977601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710051339 NPI number — MRS. ELIZABETH WILSON TRUELOVE R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUELOVE
Provider First Name:
ELIZABETH
Provider Middle Name:
WILSON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRUELOVE
Provider Other First Name:
SERRAH
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R PH
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710051339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37329-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-887-7293
Provider Business Practice Location Address Fax Number:
423-887-7022
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  8816 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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