Provider Demographics
NPI:1497237622
Name:BOBS PHARMACY LLC
Entity Type:Organization
Organization Name:BOBS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARATH
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUSUMALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-732-6915
Mailing Address - Street 1:430 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-732-6915
Mailing Address - Fax:315-732-6641
Practice Address - Street 1:430 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501
Practice Address - Country:US
Practice Address - Phone:315-732-6915
Practice Address - Fax:315-732-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies