Provider Demographics
NPI:1619225950
Name:BISE, LLC
Entity Type:Organization
Organization Name:BISE, LLC
Other - Org Name:SURGOINSVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-345-0333
Mailing Address - Street 1:114 BELLAMY AVENUE
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873
Mailing Address - Country:US
Mailing Address - Phone:423-345-0333
Mailing Address - Fax:423-345-0336
Practice Address - Street 1:114 BELLAMY AVENUE
Practice Address - Street 2:
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873
Practice Address - Country:US
Practice Address - Phone:423-345-0333
Practice Address - Fax:423-345-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy