Provider Demographics
NPI:1336234848
Name:WEBB, EDWIN TERRY (DPH)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:TERRY
Last Name:WEBB
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 1:131 MONTGOMERY LANE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803
Mailing Address - Country:US
Mailing Address - Phone:865-681-0520
Mailing Address - Fax:865-681-8226
Practice Address - Street 1:131 MONTGOMERY LANE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803
Practice Address - Country:US
Practice Address - Phone:865-681-0520
Practice Address - Fax:865-681-8226
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist