Provider Demographics
NPI:1003837535
Name:COLBERT, CURTIS RAY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:RAY
Last Name:COLBERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2490 PARR AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2030
Mailing Address - Country:US
Mailing Address - Phone:731-285-0844
Mailing Address - Fax:731-285-0885
Practice Address - Street 1:2490 PARR AVE STE 9
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2030
Practice Address - Country:US
Practice Address - Phone:731-285-0844
Practice Address - Fax:731-285-0885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6475260001Medicare NSC
TN3914065Medicare UPIN