Provider Demographics
NPI:1508476938
Name:GOBO, ANTONIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:GOBO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LINCOLN CIR APT 226
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-5853
Mailing Address - Country:US
Mailing Address - Phone:973-903-1095
Mailing Address - Fax:
Practice Address - Street 1:4000 GARDEN CITY DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2368
Practice Address - Country:US
Practice Address - Phone:202-963-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218906183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist