Provider Demographics
NPI:1679895478
Name:OSBORNE, TOBIAS J (RPH)
Entity type:Individual
Prefix:MR
First Name:TOBIAS
Middle Name:J
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1887 PLUM VALLEY RD NE
Mailing Address - Street 2:
Mailing Address - City:MANCELONA
Mailing Address - State:MI
Mailing Address - Zip Code:49659-9239
Mailing Address - Country:US
Mailing Address - Phone:231-360-2008
Mailing Address - Fax:
Practice Address - Street 1:6455 US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9306
Practice Address - Country:US
Practice Address - Phone:231-938-1181
Practice Address - Fax:231-938-0093
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist