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General NPI Number Information
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NPI Number | 1093310062
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Entity Type | Individual
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Provider Name | BOBBY OUTLAW PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 7301 HILLSIDE RD
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City | AMARILLO
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State | TX
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Zip | 79119-7395
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Country | US
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Telephone | 806-677-0452
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Fax |
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Provider Business Mailing Address
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Address Line | 9000 BIG HORN TRL
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City | AMARILLO
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State | TX
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Zip | 79108-1982
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Country | US
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Telephone | 940-577-0015
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63016
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License Number State | TX
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