Provider Demographics
NPI:1659905727
Name:KING, BOBBIE-JO MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BOBBIE-JO
Middle Name:MARIE
Last Name:KING
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:W245S7360 HEATHER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9361
Mailing Address - Country:US
Mailing Address - Phone:414-731-3892
Mailing Address - Fax:
Practice Address - Street 1:19333 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4198
Practice Address - Country:US
Practice Address - Phone:262-785-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18383-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist