Provider Demographics
NPI:1457318842
Name:SURBER, BILL ALLEN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BILL
Middle Name:ALLEN
Last Name:SURBER
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 1:150 BROWNING LANE
Mailing Address - Street 2:
Mailing Address - City:HARROGATA
Mailing Address - State:TN
Mailing Address - Zip Code:37752
Mailing Address - Country:US
Mailing Address - Phone:423-869-3980
Mailing Address - Fax:
Practice Address - Street 1:170 BEECH ST
Practice Address - Street 2:STE 1
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752
Practice Address - Country:US
Practice Address - Phone:423-869-3684
Practice Address - Fax:423-869-0702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3534183500000X
KY6891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist