MEDICARE: BOBS PHARMACY & DIABETIC SUPPLIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH22556	FL

General Provider Information

NPI Number	:	1629270491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBS PHARMACY & DIABETIC SUPPLIES

Provider Business Mailing Address
First Line	:	2860 HWY 17 N
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-1435
Country	:	US
Telephone Number	:	863-293-6084
Fax Number	:	863-293-8307

Provider Business Practice Location Address
First Line	:	2860 HIGHWAY 17 NORTH
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-1435
Country	:	US
Telephone Number	:	863-293-6084
Fax Number	:	863-293-8307

Authorized Official
Title or Position	:	ADMINISTRATIVE ASST.
Name	:	MRS. DANIELLE RODRIGUEZ
Credential	:
Telephone Number	:	863-293-6084

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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