Provider Demographics
NPI:1548268055
Name:DISHMAN, BOB N (RPH)
Entity type:Individual
Prefix:MR
First Name:BOB
Middle Name:N
Last Name:DISHMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-5610
Mailing Address - Country:US
Mailing Address - Phone:580-353-8560
Mailing Address - Fax:580-353-7985
Practice Address - Street 1:1310 SW LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-5610
Practice Address - Country:US
Practice Address - Phone:580-353-8560
Practice Address - Fax:580-353-7985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist