Healthcare Provider Details

I. General information

NPI: 1164025326
Provider Name (Legal Business Name): AMY JO TOBIN PHARM D, RPH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 S 13TH ST STE A
TEKAMAH NE
68061-1308
US

IV. Provider business mailing address

404 N 15TH ST
TEKAMAH NE
68061-1017
US

V. Phone/Fax

Practice location:
  • Phone: 402-374-2500
  • Fax: 402-374-2702
Mailing address:
  • Phone: 402-374-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10545
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: