Provider Demographics
NPI:1124676085
Name:HAAS, BOBBY RAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:RAY
Last Name:HAAS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 ORANGE TPKE
Mailing Address - Street 2:
Mailing Address - City:SLOATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10974-2317
Mailing Address - Country:US
Mailing Address - Phone:845-753-9675
Mailing Address - Fax:
Practice Address - Street 1:62 ORANGE TPKE
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-2317
Practice Address - Country:US
Practice Address - Phone:845-753-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist