Provider Demographics
NPI:1477952331
Name:WOBBY, KATHLEEN ROSE
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ROSE
Last Name:WOBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5967
Mailing Address - Country:US
Mailing Address - Phone:802-655-2536
Mailing Address - Fax:
Practice Address - Street 1:66 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5967
Practice Address - Country:US
Practice Address - Phone:802-655-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-17
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.010084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist