MEDICARE: SHELBEY BLAKE CORBIN PHARMD

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	183500000X	Pharmacist	46481	TN

General Provider Information

NPI Number	:	1972361483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBEY BLAKE CORBIN PHARMD

Provider Business Mailing Address
First Line	:	1316 BLACK JACK RD
Second Line	:
City	:	ROCKWOOD
State	:	TN
Zip	:	37854-5248
Country	:	US
Telephone Number	:	865-805-2748
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 ROANE STATE HWY
Second Line	:
City	:	HARRIMAN
State	:	TN
Zip	:	37748-8306
Country	:	US
Telephone Number	:	865-717-2835
Fax Number	:

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

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

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