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General NPI Number Information
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NPI Number | 1124569173
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Entity Type | Individual
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Provider Name | TOBIAS DOHERTY PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 03/09/2017
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Provider Practice Location Address
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Address Line | 7701 GREEN BAY RD
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City | KENOSHA
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State | WI
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Zip | 53142-4043
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Country | US
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Telephone | 262-612-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 1146 WINDBROOKE DR APT 202
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-2317
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Country | US
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Telephone | 636-734-4007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051300106
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1873940
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License Number State | WI
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