MEDICARE: MR. DAVID W BOBB R.PH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-12113	OH
2	183500000X	Pharmacist	0202214515	VA

General Provider Information

NPI Number	:	1841297090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID W BOBB R.PH

Provider Business Mailing Address
First Line	:	5302 MACDONALD RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5885
Country	:	US
Telephone Number	:	571-285-3930
Fax Number	:

Provider Business Practice Location Address
First Line	:	5302 MACDONALD RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5885
Country	:	US
Telephone Number	:	571-285-3930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/18/2016

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