Provider Demographics
NPI:1215264346
Name:FANCHER, BOBBY (RPH)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:FANCHER
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 1:100 SE GREEN OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1640
Mailing Address - Country:US
Mailing Address - Phone:817-419-0585
Mailing Address - Fax:817-419-0583
Practice Address - Street 1:100 SE GREEN OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1640
Practice Address - Country:US
Practice Address - Phone:817-419-0585
Practice Address - Fax:817-419-0583
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist