Provider Demographics
NPI:1932298585
Name:BOBS PHARMACY
Entity Type:Organization
Organization Name:BOBS PHARMACY
Other - Org Name:BOBS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-631-8174
Mailing Address - Street 1:210 SW 89TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-8532
Mailing Address - Country:US
Mailing Address - Phone:405-631-8174
Mailing Address - Fax:405-631-8164
Practice Address - Street 1:210 SW 89TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8532
Practice Address - Country:US
Practice Address - Phone:405-631-8174
Practice Address - Fax:405-631-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OK726973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2073932OtherPK
OK100238210AMedicaid
0582450001Medicare NSC