Provider Demographics
NPI:1891891487
Name:COLBURN, WILLIAM BRUCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRUCE
Last Name:COLBURN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-0309
Mailing Address - Country:US
Mailing Address - Phone:423-775-3030
Mailing Address - Fax:423-775-6147
Practice Address - Street 1:7787 RHEA COUNTY HWY
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-5982
Practice Address - Country:US
Practice Address - Phone:423-775-3030
Practice Address - Fax:423-775-6147
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist