Provider Demographics
NPI:1134404320
Name:DOBSON, JEAN ANN (RPH)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:DOBSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2803
Mailing Address - Country:US
Mailing Address - Phone:608-757-1261
Mailing Address - Fax:608-757-1451
Practice Address - Street 1:1740 CENTER AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2803
Practice Address - Country:US
Practice Address - Phone:608-757-1261
Practice Address - Fax:608-757-1451
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12487-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist