Provider Demographics
NPI:1538707062
Name:HAN, BOBY (RPH)
Entity Type:Individual
Prefix:
First Name:BOBY
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13166 W PROGRESS CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-4538
Mailing Address - Country:US
Mailing Address - Phone:615-964-9391
Mailing Address - Fax:
Practice Address - Street 1:25637 CONIFER RD
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9078
Practice Address - Country:US
Practice Address - Phone:303-816-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412076183500000X
TN43809183500000X
ORRPH-001758183500000X
COPHA.0022829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist