Provider Demographics
NPI:1164025326
Name:TOBIN, AMY JO (PHARM D, RPH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:TOBIN
Suffix:
Gender:F
Credentials:PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:TEKAMAH
Mailing Address - State:NE
Mailing Address - Zip Code:68061-1017
Mailing Address - Country:US
Mailing Address - Phone:402-374-2412
Mailing Address - Fax:
Practice Address - Street 1:412 S 13TH ST STE A
Practice Address - Street 2:
Practice Address - City:TEKAMAH
Practice Address - State:NE
Practice Address - Zip Code:68061-1308
Practice Address - Country:US
Practice Address - Phone:402-374-2500
Practice Address - Fax:402-374-2702
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist