NPIMap

Individual provider Active NPI

Jonathan Tyler Bobo, PHARMD

  • Pharmacist
  • Iuka, MS
National Provider Identifier
1033798129
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
E15090 Issued in MS
Practice address
1519 W Quitman St
Iuka, MS 38852-1132
Phone
(662) 426-3629
Fax
(662) 423-3620
NPI assigned
Apr 6, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X E15090 MS Primary

Addresses

Primary practice location

1519 W Quitman St
Iuka, MS 38852-1132

Mailing address

1519 W Quitman St
Iuka, MS 38852-1132
Phone (662) 426-3629

Other practice location 1

1244 E Main St
Tupelo, MS 38804-2952
Phone (662) 844-7811

Other practice location 2

603 S Highway 365
Burnsville, MS 38833-9706
Phone (662) 427-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
E15090MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Burnsville Health Solutions LLC Current Accepting new patients
Burns Inc Pharmacist Past Accepting new patients
Burns Inc Past Accepting new patients
Burns Inc PastSince Apr 11, 2021 Accepting new patients
Dawson Drugs PastSince Apr 11, 2021 Accepting new patients

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1033798129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 W QUITMAN ST",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521132",
            "telephone_number": "662-426-3629",
            "fax_number": "662-423-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 W QUITMAN ST",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521132",
            "telephone_number": "662-426-3629",
            "fax_number": "662-423-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1244 E Main St",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388042952",
            "country_code": "US",
            "telephone_number": "662-844-7811",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "603 S Highway 365",
            "address_purpose": "LOCATION",
            "city": "Burnsville",
            "state": "MS",
            "postal_code": "388339706",
            "country_code": "US",
            "telephone_number": "662-427-0100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBO",
        "first_name": "JONATHAN",
        "middle_name": "TYLER",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-06",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E15090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Iuka, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.