Provider Demographics
NPI:1548667389
Name:TOBAEE, JEFFAR (PHARMD)
Entity type:Individual
Prefix:
First Name:JEFFAR
Middle Name:
Last Name:TOBAEE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22775 N RD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-8622
Mailing Address - Country:US
Mailing Address - Phone:620-704-0711
Mailing Address - Fax:
Practice Address - Street 1:101 S 6TH ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2306
Practice Address - Country:US
Practice Address - Phone:785-742-2125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS116758183500000X
NE14636183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist