MEDICARE: DR. BOBBY DALE ELEY DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	1300	TN

General Provider Information

NPI Number	:	1639337082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY DALE ELEY DPH

Provider Business Mailing Address
First Line	:	11222 LEBANON RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	615-773-2300
Fax Number	:	615-773-2308

Provider Business Practice Location Address
First Line	:	11222 LEBANON RD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-5504
Country	:	US
Telephone Number	:	615-773-2300
Fax Number	:	615-773-2308

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2008
Last Update Date	:	05/31/2008

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