Provider Demographics
NPI:1861868465
Name:WILLIS, ELIZABETH ASHLEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:WILLIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1355 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1715
Mailing Address - Country:US
Mailing Address - Phone:731-472-1011
Mailing Address - Fax:731-212-3082
Practice Address - Street 1:1355 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1715
Practice Address - Country:US
Practice Address - Phone:731-658-5271
Practice Address - Fax:731-658-0870
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist