Provider Demographics
NPI:1265441984
Name:BULLINGTON, ROBERT WAYNE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:BULLINGTON
Suffix:
Gender:M
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 1:5337 SUMMER ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-8134
Mailing Address - Country:US
Mailing Address - Phone:865-688-1597
Mailing Address - Fax:
Practice Address - Street 1:524 ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:STRAWBERRY PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37871-1015
Practice Address - Country:US
Practice Address - Phone:865-933-4149
Practice Address - Fax:865-933-4037
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist