Provider Demographics
NPI:1013291699
Name:BOBO, MARKITA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARKITA
Middle Name:
Last Name:BOBO
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 1:60 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1522
Mailing Address - Country:US
Mailing Address - Phone:413-786-1126
Mailing Address - Fax:
Practice Address - Street 1:60 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1522
Practice Address - Country:US
Practice Address - Phone:413-786-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist