Provider Demographics
NPI:1992874333
Name:HOBACK, NORMAN ALLEN (BS)
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:ALLEN
Last Name:HOBACK
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PEBBLE HILL DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-2248
Mailing Address - Country:US
Mailing Address - Phone:618-616-7991
Mailing Address - Fax:618-398-4511
Practice Address - Street 1:6 PEBBLE HILL DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-2248
Practice Address - Country:US
Practice Address - Phone:618-616-7991
Practice Address - Fax:618-398-4511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045328183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist