Provider Demographics
NPI:1376633750
Name:TOBIA, COLLEEN COOK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:COOK
Last Name:TOBIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4615
Mailing Address - Country:US
Mailing Address - Phone:352-246-3878
Mailing Address - Fax:
Practice Address - Street 1:2200 NORTH HIGHWAY A1A
Practice Address - Street 2:WALGREENS
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32903
Practice Address - Country:US
Practice Address - Phone:321-773-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS420011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist