Healthcare Provider Details

I. General information

NPI: 1831108471
Provider Name (Legal Business Name): EDWARD BISSELL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/09/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 ANDREW JOHNSON HWY
STRAWBERRY PLAINS TN
37871-1015
US

IV. Provider business mailing address

524 ANDREW JOHNSON HWY
STRAWBERRY PLAINS TN
37871-1015
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-4149
  • Fax: 865-933-4037
Mailing address:
  • Phone: 865-933-4149
  • Fax: 865-933-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number812
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT WAYNE BULLINGTON
Title or Position: OWNER/PRESIDENT
Credential: PHARMD
Phone: 865-933-4149