James Matthew Bobal, RPH
Individual provider Active NPI Pharmacist · Vestal, NY
NPI 1043490071 · NPPES record last updated Nov 7, 2007
Key facts
- NPI
- 1043490071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 039042 (NY)
- Practice address
- 3701 Vestal Pkwy E
Vestal, NY 13850-2397 - Phone
- (607) 729-9141
- Fax
- (607) 729-4680
- NPI assigned
- Nov 7, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039042 | NY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eckerd Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 039042 | NY | Yes |
Addresses
Primary practice location
3701 Vestal Pkwy E
Vestal, NY 13850-2397
Mailing address
3701 Vestal Pkwy E
Vestal, NY 13850-2397
Phone (607) 729-9141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00483629 | Medicaid | NY |
Other providers in Vestal, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.