Provider Demographics
NPI:1235733593
Name:LITTLE, BOBBY (PHARMD)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:LITTLE
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 1:2 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2232
Mailing Address - Country:US
Mailing Address - Phone:765-472-4367
Mailing Address - Fax:
Practice Address - Street 1:2 S BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-2232
Practice Address - Country:US
Practice Address - Phone:765-472-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028473A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist