Provider Demographics
NPI:1750469607
Name:TOBOLSKI, TERESA MARIE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:TOBOLSKI
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:COLANTONIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:5900 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:OAKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14125-9422
Mailing Address - Country:US
Mailing Address - Phone:585-948-5165
Mailing Address - Fax:
Practice Address - Street 1:81 MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2101
Practice Address - Country:US
Practice Address - Phone:585-344-1570
Practice Address - Fax:585-344-2946
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist