Provider Demographics
NPI:1356686901
Name:BILLINGS, BOBBY GLEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:GLEN
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 SWEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7341
Mailing Address - Country:US
Mailing Address - Phone:901-494-4595
Mailing Address - Fax:
Practice Address - Street 1:2879 SWEETWOOD DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7341
Practice Address - Country:US
Practice Address - Phone:901-494-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD05707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist