Healthcare Provider Details

I. General information

NPI: 1912512484
Provider Name (Legal Business Name): AMANDA TOEBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

2737 NW 140TH ST APT 216
OKLAHOMA CITY OK
73134-6164
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-1000
  • Fax:
Mailing address:
  • Phone: 641-512-7322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23958
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: