Lacey Eldridge
Individual provider Active NPI Pharmacist · New Tazewell, TN
NPI 1346796323 · NPPES record last updated Aug 30, 2016
Key facts
- NPI
- 1346796323
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 40666 (TN)
- Practice address
- 915 Main St
New Tazewell, TN 37825-6651 - Phone
- (423) 626-5829
- NPI assigned
- Aug 30, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40666 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 40666 | TN | Yes |
Addresses
Primary practice location
915 Main St
New Tazewell, TN 37825-6651
Mailing address
915 Main St
New Tazewell, TN 37825-6651
Phone (423) 626-5829
Other providers in New Tazewell, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.