Healthcare Provider Details

I. General information

NPI: 1649181884
Provider Name (Legal Business Name): AMY FAE THOBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PL
BRONX NY
10461-2720
US

IV. Provider business mailing address

1070 NOSTRAND AVE
BROOKLYN NY
11225-4120
US

V. Phone/Fax

Practice location:
  • Phone: 646-874-2282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number072282
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: