=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760808372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOBO PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2014
-----------------------------------------------------
Last Update Date | 03/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6903 18TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-5076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-759-6308
-----------------------------------------------------
Fax | 718-759-6309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6903 18TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-5076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-759-6308
-----------------------------------------------------
Fax | 718-759-6309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LINJUE HUA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-759-6308
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 032651
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------