Provider Demographics
NPI:1255452629
Name:CORLEY, ALAN BRUCE (DPH)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BRUCE
Last Name:CORLEY
Suffix:
Gender:M
Credentials:DPH
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 874
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37744-0874
Mailing Address - Country:US
Mailing Address - Phone:423-638-7552
Mailing Address - Fax:423-638-2552
Practice Address - Street 1:1004 SNAPPS FERRY RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4029
Practice Address - Country:US
Practice Address - Phone:423-638-7552
Practice Address - Fax:423-638-2552
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist