Individual
MR. JACK EDWARD BULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPH.
Contact information
Practice address
239 W SUMMER ST, GREENEVILLE, TN 37743-4925
(423) 638-4711
(423) 638-3311
Mailing address
104 STRATFORD DR, GREENEVILLE, TN 37743-6638
(423) 639-4354
(423) 638-3311
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
458
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454403
—
TN
Enumeration date
02/20/2007
Last updated
07/08/2007
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