=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023399714
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEVIN D BOBST RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2011
-----------------------------------------------------
Last Update Date | 09/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1805 BRADY ST
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-322-5933
-----------------------------------------------------
Fax | 563-322-3850
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 SHAWNEE CIR
-----------------------------------------------------
City | ELDRIDGE
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52748-9523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-285-7595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15910
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------