Provider Demographics
NPI:1750943874
Name:HOBAN, KERRY (PHARM D)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HOBAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:
Other - Last Name:GRABOWSKI-HOBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:69 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69 HICKORY DR
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1011
Practice Address - Country:US
Practice Address - Phone:781-373-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist