Provider Demographics
NPI:1659603470
Name:KETSHABILE-NKOBELA, KESEGOFTSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KESEGOFTSE
Middle Name:
Last Name:KETSHABILE-NKOBELA
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 1:1150 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2863
Mailing Address - Country:US
Mailing Address - Phone:928-783-6834
Mailing Address - Fax:928-783-3377
Practice Address - Street 1:1150 W 8TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2863
Practice Address - Country:US
Practice Address - Phone:928-783-6834
Practice Address - Fax:928-783-3377
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14343183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist