Provider Demographics
NPI:1831108471
Name:EDWARD BISSELL INC
Entity Type:Organization
Organization Name:EDWARD BISSELL INC
Other - Org Name:EAST TENNESSEE DISCOUNT DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BULLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-933-4149
Mailing Address - Street 1:524 ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-1015
Mailing Address - Country:US
Mailing Address - Phone:865-933-4149
Mailing Address - Fax:865-933-4037
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8123336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2096135OtherPK
TN1454935Medicaid
TN1454935Medicaid