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General NPI Number Information
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NPI Number | 1154603314
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Entity Type | Individual
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Provider Name | BOBBY DODD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 808 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2022
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Country | US
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Telephone | 870-642-8021
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Fax | 870-642-8357
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Provider Business Mailing Address
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Address Line | 4502 SUZANNE AVE
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City | TEXARKANA
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State | TX
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Zip | 75503-0403
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Country | US
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Telephone | 903-832-9989
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Fax | 870-642-8357
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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 | PD06130
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License Number State | AR
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