MEDICARE: MR. TOBIAS J OSBORNE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302032068	MI

General Provider Information

NPI Number	:	1679895478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOBIAS J OSBORNE RPH

Provider Business Mailing Address
First Line	:	1887 PLUM VALLEY RD NE
Second Line	:
City	:	MANCELONA
State	:	MI
Zip	:	49659-9239
Country	:	US
Telephone Number	:	231-360-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	6455 US HIGHWAY 31 N
Second Line	:
City	:	WILLIAMSBURG
State	:	MI
Zip	:	49690-9306
Country	:	US
Telephone Number	:	231-938-1181
Fax Number	:	231-938-0093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	02/19/2010

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