Provider Demographics
NPI:1407072424
Name:BOBO, JAY ALLISON
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLISON
Last Name:BOBO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JAY
Other - Middle Name:ALLISON
Other - Last Name:BOBO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:250 SAINT ANDREWS FWY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-7717
Mailing Address - Country:US
Mailing Address - Phone:901-680-8198
Mailing Address - Fax:
Practice Address - Street 1:865 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-4608
Practice Address - Country:US
Practice Address - Phone:901-524-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist