Provider Demographics
NPI:1528492378
Name:DEATHERIDGE, ANNE W (PHARM D)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:W
Last Name:DEATHERIDGE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 FAIRVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9078
Mailing Address - Country:US
Mailing Address - Phone:615-799-0691
Mailing Address - Fax:
Practice Address - Street 1:201 SMYTHE ST
Practice Address - Street 2:APT 304
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-3567
Practice Address - Country:US
Practice Address - Phone:615-830-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist