Healthcare Provider Details

I. General information

NPI: 1336417377
Provider Name (Legal Business Name): BETH ANN KOBASA R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 CAPITOL TRL
NEWARK DE
19711-7242
US

IV. Provider business mailing address

2659 CAPITOL TRL
NEWARK DE
19711-7242
US

V. Phone/Fax

Practice location:
  • Phone: 302-453-1010
  • Fax:
Mailing address:
  • Phone: 302-453-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP034097L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0002736
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: