Provider Demographics
NPI:1336688043
Name:FOLK, ERIC ALAN (DPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALAN
Last Name:FOLK
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 NUCKOLLS RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-1599
Mailing Address - Country:US
Mailing Address - Phone:731-658-5294
Mailing Address - Fax:731-659-3918
Practice Address - Street 1:629 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1599
Practice Address - Country:US
Practice Address - Phone:731-658-5294
Practice Address - Fax:731-659-3918
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist