=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588208235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOB CURRY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2019
-----------------------------------------------------
Last Update Date | 11/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 178 E SHELDON ST
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-3114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-776-1936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3131 N MAIN ST APT M102
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2536
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-313-3457
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Pharmacology Physician
-----------------------------------------------------
License Number | S023507
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------