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1801913611 NPI number — BOBBY LEAVORN ETCHASON R.PH.

NPI Number: 1801913611
Health Care Provider/Practitioner: BOBBY LEAVORN ETCHASON R.PH.

Information about “1801913611” NPI (BOBBY LEAVORN ETCHASON R.PH.) exists in 1801913611 in HTML format HTML  |  1801913611 in plain Text format TXT  |  1801913611 in PDF (Portable Document Format) PDF  |  1801913611 in an XML format XML  formats.

NPI Number : 1801913611 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801913611",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ETCHASON",
    "FirstName": "BOBBY",
    "MiddleName": "LEAVORN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "R.PH.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4446 KERTH CIRCLE XING",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63128-3131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-892-1792",
    "MailingAddressFaxNumber": "636-282-0816",
    "FirstLinePracticeLocationAddress": "1253 WATER TOWER PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ARNOLD",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63010-2142",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "636-282-0803",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/25/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "029042",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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