Provider Demographics
NPI:1053452193
Name:SEGRAVES, ELIZABETH MARY (PHARMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:SEGRAVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10932 THORNTON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2922
Mailing Address - Country:US
Mailing Address - Phone:865-675-1405
Mailing Address - Fax:865-671-1981
Practice Address - Street 1:11424 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3915
Practice Address - Country:US
Practice Address - Phone:865-966-9728
Practice Address - Fax:865-671-1981
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7935183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist