NO NAMA LENGKAP & GELAR PC ASAL NAMA INSTANSI ALAMAT NO.

HP NO SKK NO KTA
1 Dra. TITIK INDRAWATI, Apt. BOJONEGORO APOTEK INDRIA JL. Dr. CIPTO NO. 129, BOJONEGORO 081357903637

2 ADINIA, S.Farm., Apt. BOJONEGORO APOTEK BAURENO FARMA JL. RAYA PASINAN NO. 210, BAURENO, 081330235630
BOJONEGORO
JL. AKBAR Gg. MELATI RT 33/ RW 02,
3 AGUNG TRIANJONO, S.Farm., Apt. BOJONEGORO RS MUNA ANGGITA 08113530666
BOJONEGORO
Dsn. PURWOREJO RT 22/ RW 04 Ds. KEPUNG,
4 AJENG PERMATA ULFAH, S.Farm., Apt. BOJONEGORO APOTEK DANDER 085647079021
KEPUNG, KEDIRI
JL. LETDA NURHASYIM NO. 456 KALIANYAR,
5 ALHAMI SEPTININGRUM, S.Si., Apt. BOJONEGORO APOTEK EL KAPAS, BOJONEGORO 085236117118

JL. RAYA BOJONEGORO-CEPU NO. 20, 081232947927 /

6 ANA NURLAILI HIDAYAH, S.Farm., Apt. BOJONEGORO APOTEK MAJU MAPAN FARMA PANJUNAN, KALITIDU, BOJONEGORO 085733399963 008/IAI-JATIM/KTA/III/2015 15031987025097
7 ANDRI HARMONO, S.Farm., Apt. BOJONEGORO APOTEK KEPOHBARU _ _
JL. MONGINSIDI KAMPUNG BARU Gg. 2 NO. 6,
8 ANINDYA RIZKY DEWANGGANI, S.Farm., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO 082136343873
BOJONEGORO

9 ANITA FAJARWATI, S.Farm., Apt. BOJONEGORO APOTEK PENGKOK FARMA JL. DR. SUTOMO NO. 88 RT 21/RW 06, Dsn. 082132878952
PENGKOK, PADANGAN, BOJONEGORO
Ket-011/PD.IAI/JATIM/XI/2015 1011983035449

10 ANITA RACHMAWATI, S.Farm., Apt., M.Kes. BOJONEGORO __ JL. KH. HASYIM ASHARI NO. 23, BOJONEGORO 081252383960

11 ARDHANI WIDYANINGRUM, S.Farm., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO WISMA INDAH BARU BLOK F-4, BOJONEGORO 085234750189

Dsn. MINDI RT 15/ RW 03 Ds. SUGIHWARAS,

12 ARI ASTUTIK WULANDARI, S.Farm., Apt., BOJONEGORO APOTEK KEDUNGADEM SUGIHWARAS, BOJONEGORO 081393958609

JL. BASUKI RAHMAD Gg. NAMLO NO. 30,

13 ARIFAH NURAINI, S.Si., Apt. BOJONEGORO APOTEK SIMPANG LIMA BOJONEGORO 082299764499

Dsn. MEJASEM, RT 04/ RW 04, Ds. BAKUNG,

14 ATIKA DIKAN ISNAWATI, S.Farm., Apt BOJONEGORO APOTEK COKRO MEDIKA 081234901231
KANOR, BOJONEGORO 008/IAI-JATIM/KTA/III/2015 3081987025116
PENGKOK RT 17/RW 05, PADANGAN,
15 AYU BUDAYA, S.Farm., Apt. BOJONEGORO APOTEK TAJI BOJONEGORO 089696153095
25021984025123

16 BELINDA ARBITYA DEWI, S.Farm., Apt. BOJONEGORO APOTEK KARUNIA PERUM PERMATA TLASEH, Gg. H. CHOZIN 081391258009
BLOK F NO. 80, DANDER, BOJONEGORO
WISMA INDAH BARU BLOK G NO. 69,
17 CHRISTINE FERLINA, S.Farm., Apt. BOJONEGORO APOTEK AZ-ZAHRO BOJONEGORO 085731993119

18 DAMAYANTI VINA, S.Farm., Apt. BOJONEGORO APOTEK BUDI ASIH - PURWOSARI JL. TANJUNG NO. 43, PURWOSARI, __
BOJONEGORO
JL. WONOSARI, SAMBENG, RT 14/ RW 05, 08156660073 /
19 DENI LYAWATI, S.Farm., Apt. BOJONEGORO APOTEK SEHAT KASIMAN
KASIMAN, BOJONEGORO 082221055351 14101983025109
JL. MH. THAMRIN Gg. NGALIMUN
20 DEWI KARTIKA SARI, S.Farm., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO PERUMAHAN THAMRIN INDAH REGENCY BLOK 085645339776
B-3, BOJONEGORO
Ds. SIWALAN RT 14/ RW 06, SUGIHWARAS,
21 DIAN SETYA PUTRI, S.Farm., Apt. BOJONEGORO APOTEK KANOR FARMA BOJONEGORO 082333356675

22 DITO GALIH PRASETYO, S.Far., Apt. BOJONEGORO APOTEK PURWOSARI FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO 08982806929
JL. JAKSA AGUNG SUPRAPTO NO. 232,
23 Dra. IRENE HELIANA DJAJA, Apt. BOJONEGORO APOTEK BHAKTI 0811373309
BOJONEGORO 7081946009246

24 Drs. ABDUL BAHRY, Apt. BOJONEGORO APOTEK CENDANA MITRA FARMA JL. GUBENG KERTAJAYA 9C NO. 1, SURABAYA 085257218258

25 Drs. MOHAMMAD IHSAN, M.Si., Apt. BOJONEGORO APOTEK PANGSUD PERUMDA BLOK C-4, BOJONEGORO 08123161653 3031963009253
26 Drs. SUNDORO TANTO, Apt. BOJONEGORO APOTEK BINTANG JL. MH. THAMRIN NO.32, SURABAYA 0818334673 22071966009266
JL. RAYA DANDER NO. 68 RT 23/ RW O3,
27 DWI AYU AGUSTINA, S.Farm., Apt. BOJONEGORO APOTEK DANDER DANDER, BOJONEGORO 085702274409
Ket-009/PD.IAI/JATIM/IX/2015 0
28 DWIANTO ADHI NUGROHO, S.Farm., Apt. BOJONEGORO APOTEK DWI GRAHA SUKSES JL. Dr. CIPTO NO. 129, BOJONEGORO 081331099078 008/IAI-JATIM/KTA/III/2015 16091983025112
29 ELFINA DEWI SYANTI, S.Si., Apt. BOJONEGORO RS MUHAMMADIYAH KALITIDU JL. RAYA KALITIDU NO. 266 BOJONEGORO 081319908025
30 ENDAH WAHYUNINGSARI, S.Farm., Apt. BOJONEGORO APOTEK PARADIGMA JL. MASTRIP NO. 90, BOJONEGORO 082230548327

31 ENDRI AMPRIANI RAHAYU S.Farm.,Apt BOJONEGORO APOTEK TAMBAKREJO FARMA Jl.Raya 06 Sukorejo Tambakrejo Bojonegoro 085655246756

32 ERIA FARIHA, S.Farm., Apt. BOJONEGORO APOTEK KITA JL. RAYA RT 05/RW 01, SOBONTORO, BALEN, 081235700703
BOJONEGORO 008/IAI-JATIM/KTA/III/2015 27011984025119
33 ERNA HARYATI, S.Si., Apt. BOJONEGORO APOTEK DIPONEGORO JL. DIPONEGORO NO. 26A, BOJONEGORO 082232291279 18101973009235

34 EVA OETOMO, S.Si., Apt. BOJONEGORO APOTEK SINAR JL. AKBP M. SUROKO NO. 18, BOJONEGORO 08175112288
11021979000237
35 FAIK FAUZI, S.Farm., Apt. BOJONEGORO APOTEK MULIA FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO 081331225346

36 FAIVA MURIANDINI, S.Si., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO PERUMDA BLOK B-22, BOJONEGORO 081335343395

37 FARADINA ROSITA, S.Farm., Apt. BOJONEGORO APOTEK FARADINA JL. TEUKU UMARNO. 79A, BOJONEGORO 081269810111
38 FEMMY SUGIANTO, S.Farm., Apt. BOJONEGORO APOTEK BETHEL JL. DIPONEGORO NO. 86, BOJONEGORO 08123243231 24041984009240

39 FETTY ZUBAIDHAH, S.Farm., Apt. BOJONEGORO APOTEK AL KHANZA JL. MONGINSIDI III/3 SUKOREJO, BOJONEGORO 0816555230
008/IAI-JATIM/KTA/III/2015 1051983025118
40 FITRI WULANSARI, S.Farm., Apt. BOJONEGORO APOTEK AVERA SEMAMPIR RENGAH 4 NO. 5, SURABAYA 081330366033 22081981009241
TOKO MANDALA JL. DIPONEGORO,
98 FLORA ANITASARI, S.Farm., Apt. BOJONEGORO APOTEK BANJARSARI 081703653071
BOJONEGORO

41 FRANSISCA WIDIANINGRUM, S.Si, Apt. BOJONEGORO APOTEK SOLUSI SEHAT JL. M.H. THAMRIN NO. 103D, BOJONEGORO 0817301016
62100 11061978009244

42 FRANSISKUS RONY ISMANTO, S.Si., Apt. BOJONEGORO APOTEK TRIO SAHABAT JL. WR SUPRATMAN NO. 2A, BOJONEGORO 0816532930

JL. JAKSA AGUNG SUPRAPTO NO. 232,

43 GRACE ARNICA HARJANTO, S.Si., Apt. BOJONEGORO APOTEK NUSA 0811361192
BOJONEGORO 23041978009245
WISMA INDAH BARU BLOK G NO. 64,
44 HERYANTI PUSPARISA, S.Si., Apt. BOJONEGORO RS. WAHYU TUTUKO BOJONEGORO 08123584353
14091976009246
45 HEVY ANDRIANI, S.Farm., Apt. BOJONEGORO APOTEK TUMBRAS - KEDUNGADEM JL. Dr. WAHIDIN NO. 2, BOJONEGORO 082219020279 008/IAI-JATIM/KTA/IV/2015 18121982025139

46 IKA INDRIAWATI, S.Si., Apt. BOJONEGORO APOTEK KEDUNG WARAS JL. WR SUPRATMAN NO. 2A, BOJONEGORO 081359898987
28121987009247
TOSERBA JL. RAYA KEDUNGADEM,
47 INDAH YUNI SUSWANTI, S.Farm., Apt. BOJONEGORO APOTEK MANJUR - KEDUNGADEM BOJONEGORO 085232780086
11061983009248

48 INDRIYANI, S.Si., Apt. BOJONEGORO APOTEK LANCAR FARMA JL. RAYA NO. 150 SUMURAGUNG, 081230387777
SUMBERREJO, BOJONEGORO

49 INNEKE DIAN RAHMA, S.Farm., Apt. BOJONEGORO APOTEK SALSABILA JL. GAJAH MADA BOK B3- B4, BOJONEGORO 085755928559

50 IRMA HIDHAYATUL RAHMI, S.Farm., Apt. BOJONEGORO RSUD SUMBERREJO PACUL PERMAI BLOK G-1, BOJONEGORO 62114 085648979790
9111986009250
JL. MH. THAMRIN Gg. MAWAR NO. 3
51 ITA DIANITA WULANDARI, S.Farm., Apt. BOJONEGORO APOTEK MANJUR BALEN 081231544404
BOJONEGORO 008/IAI-JATIM/KTA/III/2015 30101982025111
JL. RAYA BAURENO NO. 227, BAURENO,
52 KHOIRUL LUKMAN HAKIM, S.Farm., Apt. BOJONEGORO APOTEK RAZQA - BAURENO BOJONEGORO 082230279780

JL. RAJEKWESI NO. 62 RT 01/ RW 01 Ds.

53 KUKUH LESTARI, S.Farm., Apt. BOJONEGORO APOTEK PARAMEDINA TAPELAN, KAPAS, BOJONEGORO 0821225555480
25031982028938/1108022

54 LENI KURNIAWATI, S.Farm., Apt. BOJONEGORO APOTEK PATOMAN Ds. SEMBUNG LOR RT 07/ RW 04, BAURENO, 085648050280
BOJONEGORO 008/IAI-JATIM/KTA/IV/2015 18091986025142
55 LINAWATI, S.Farm., Apt. BOJONEGORO APOTEK TUNGGAL JL. VETERAN NO. 120, BOJONEGORO 087855529091 141119821290311
56 LUSI LIESAWATI, S.Si., Apt. BOJONEGORO APOTEK BUDI JAYA JL. Dr. CIPTO NO. 53A, BOJONEGORO 08123585619 - 13021979009252

57 MEI ANJAR KUSSUMA, S.Farm., Apt. BOJONEGORO APOTEK SEHAT JL. KLAMPIS SEMOLO BARAT J-33, SURABAYA 08563073009

58 MIMING ANTIKA DIESTANINGRUM, S.Farm., Apt. BOJONEGORO RS ISLAM MUHAMMADIYAH SUMBERREJO JL. DR. SUHARSO NO.19, BOJONEGORO 085655228252

JL. RAYA KEDUNGADEM Ds. BANJAREJO,

59 MUHAMMAD KHALID RIJALUDDIN, S.Farm, Apt. BOJONEGORO APOTEK ASY SYIFA POHWATES, BOJONEGORO 085852038949

60 MUMAYA ZAUHARA, S.Farm., Apt. BOJONEGORO APOTEK MUMAYA FARMA BADUG RT 02/ RW 03, SUMURAGUNG, 08123239083
SUMBERREJO, BOJONEGORO
KLINIK RAWAT INAP MUHAMMADIYAH JL. RAYA NDROKILO, Ds. NDROKILO,
61 NELLY FRONIKA SITUMORANG, S.Farm., Apt. BOJONEGORO 081316253779
KEDUNGADEM KEDUNGADEM, BOJONEGORO 8081988025131
08121768889/
62 NILUH INDRAWATI, S.Farm., Apt. BOJONEGORO APOTEK GLORY JL. KS TUBUN NO. 33, BOJONEGORO 081336338999

63 NOVI HIDAYAH, S.Farm., Apt. BOJONEGORO APOTEK WARDOYO JL. DR. SUTOMO NO.204 PASINAN, BAURENO, 081312018000
BOJONEGORO
64 NOVITRI WULANDARI, S.Farm., Apt. BOJONEGORO RS. 'AISYIYAH BOJONEGORO JL. HASYIM ASY’ARI NO. 17 BOJONEGORO __
JL. DAHLIA NO. 11, WISMA INDAH TENGAH,
65 NUR ENDAH PURNOMO, S.Farm., Apt. BOJONEGORO APOTEK JOGLO BOJONEGORO 081328401500
008/IAI-JATIM/KTA/IV/2015 10091982025138
JL. KI HAJAR DEWANTARA NO. 20,
66 NUR IHSANI YUSUF, S.Si., Apt BOJONEGORO APOTEK PRIMA FARMA BOJONEGORO 081242145677
008/IAI-JATIM/KTA/II/2015 7061987025048

67 NUR SUKMO SUDARMONO, S.Si., Apt. BOJONEGORO APOTEK EKA SUGIHWARAS JL. RAYA KAPAS NO. 89, KAPAS, BOJONEGORO 085745907074

Ds. CANGA'AN NO. 93 RT 02/RW 01, KANOR,

68 NURUL MA'RIFAH, S.Farm., Apt. BOJONEGORO APOTK DMC - DANDER 081234831494
BOJONEGORO
JL. PANGLIMA SUDIRMAN NO. 2,
69 PRATIDINA ARADHANI, S.Farm., Apt. BOJONEGORO APOTEK BOJONEGORO BOJONEGORO 081703249579

70 PUJI RAHAYU, S.Si., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO JL. LETTU SUWOLO Gg. PRIBADI BLOK A, 081233096830
BOJONEGORO
71 RAMADHAN BAYUMURTHY, S.Far., Apt. BOJONEGORO APOTEK EBA MEDIKA FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO 085725857979

72 RATNA WULANDARI, S.Farm., Apt. BOJONEGORO APOTEK KENZIE FARMA JL. RAYA CEPU NO. 6, KALITIDU, BOJONEGORO __

97 RHANUGA HARMUSYANTO, S.Farm., Apt. BOJONEGORO APOTEK SEHAT BAROKAH JL. RAYA SOBONTORO NO. 123, BALEN 087852402602
PERUM GRAHA INDAH RUKO B-7 TIKUNG,
73 RIBUT TIRTAYANA, S.Farm., Apt. BOJONEGORO RSUD PADANGAN 085732877713
LAMONGAN
74 RIKA WAHYULI , S.Farm., Apt. BOJONEGORO APOTEK BASUKI RAHMAD JL. BASUKI RAHMAD NO. 3, BOJONEGORO 08123527272
75 ROBBY NAJINI, S.Farm., Apt BOJONEGORO APOTEK PRAPATAN FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO 08978517694
JL. DR. SUTOMO NO. 166 RT 21/ RW O6,
76 ROHKIYAT, S.Far., Apt. BOJONEGORO APOTEK NGRAHO FARMA 085729471716
PADANGAN, BOJONEGORO
JL. RAYA SUMBERREJO NO. 1180,
77 RONALD HADI WIJAYA, S.Farm., Apt. BOJONEGORO APOTEK RIDHO SEHAT 085850290928
SUMBERREJO, BOJONEGORO

78 SELVI DARIANTI, S.Farm., Apt. BOJONEGORO APOTEK SUMBER WARAS JL. SERMA MAUN BARAT NO. 87, 081703457665
BOJONEGORO 008/IAI-JATIM/KTA/V/2015 23031988028843

79 SEPTY MARTHA SARI, S.Farm., Apt. BOJONEGORO APOTEK K-24 ADIPURA JL. BRIGJEN SUTOYO N0. 17, BOJONEGORO 081335200444
088/IAI-JATIM/KTA/III/2015 21091984025117
JL. SURABAYA-CEPU NO. 39, KORGAN,
80 SETYO PUTRI PUJI LESTARI SUDJONO, S.Farm., Apt. BOJONEGORO APOTEK TOBO FARMA 085643176176
PURWOSARI, BOJONEGORO
JL. P. POLIM Gg. MANGGA III LORONG IV BLOK
81 SISCA HARNAYANTI, S.Farm., Apt. BOJONEGORO APOTEK SYIFA FARMA D3, BOJONEGORO 087887564724
29031980025012

101 SISWONO HANDOKO JATI, S. Farm., Apt. BOJONEGORO APOTEK TIRTA FARMA JL. COKROAMINOTO, DANDER, BOJONEGORO 085647403911
30031986028227
82 SOFI NUR ASLAMY, S.Farm., Apt. BOJONEGORO RS. 'AISYIYAH BOJONEGORO JL. HASYIM ASY’ARI NO. 17 BOJONEGORO __
JL. JAKSA AGUNG SUPRAPTO NO. 155,
83 SOFYAN AGUS CHRISTANTO, S.Farm., Apt. BOJONEGORO APOTEK PELANGI KASIH BOJONEGORO 085748735329

84 SRI WURYANI, S.Farm., Apt. BOJONEGORO APOTEK PADANGAN JL. DIPONEGORO NO. 165, PADANGAN, 081330296141
BOJONEGORO

PERUM GRIYA CENDANA NO. 14, SAWAHAN RT

85 SUNARTI, M.Sc., Apt. BOJONEGORO APOTEK GARAS 085643615504
03/ RW 02, NGEMPLAK, BOYOLALI

86 TIRTO AMBORO, S.Farm., Apt. BOJONEGORO APOTEK GLOBAL 556 JL. AIRLANGGA NO. 39, SURABAYA 08993395570
NGRASEH RT 15/ RW O3, DANDER,
87 TITI AGNI HUTAHAEN, S.Farm., M.Farm. Klin., Apt. BOJONEGORO RS. IBNU SINA 085731344311
BOJONEGORO
88 UMI HANIK, S.Si., Apt. BOJONEGORO RS. 'AISYIYAH BOJONEGORO JL. HASANUDIN NO. 71, BOJONEGORO 08123178312 008/IAI-JATIM/KTA/III/2015 26021973025048

89 UNGGUL ADIGUNO, S.Si., Apt. BOJONEGORO APOTEK KU JL. BOJONEGORO - DANDER NO. 489, 085775533461
BOJONEGORO
90 WINDAH EKA HARDINI, S.Farm., Apt. BOJONEGORO APOTEK ANITA FARMA SEMOLOWARU SELATAN 5/15, SURABAYA 08123102048

91 WIWIK WIDYAWATI, S.Farm., Apt. BOJONEGORO APOTEK SUMBER BAHAGIA JL. LETTU SUWOLO NO. 121, BOJONEGORO 08165407266
15041973009269
99 YESSICA IKA DEWI BOJONEGORO TIRTA AYU SPA
92 YOUSTIANA DWI RUSITA, S.Farm., M.Si., Apt. BOJONEGORO APOTEK ALIFIA JL. J.A. SUPRAPTO NO. 21, BOJONEGORO 085736275326
93 YULI SETIYANTO, S.Farm., Apt. BOJONEGORO RSI PEMUDA JL. PEMUDA NO. 29, BOJONEGORO 081615847300 008/IAI-JATIM/KTA/IV/2015 31071983025140

SIDODADI LR.2 NO. 7, RT 01/ RW 06, CEPU,

94 YUNITA SARI NUR HIDAYAH, S.Farm., Apt. BOJONEGORO APOTEK SROYO BLORA 085640123117

95 YUSITA INDRASTIWI, S.Farm., Apt. BOJONEGORO KLINIK ANS KALITIDU PERUM. NDORO ASRI, KARANG BOYO, CEPU 081259768998

96 ZAINUL ARIFIN, S.Si., Apt. BOJONEGORO RSUD DR R SOSODORO DJATIKOESOEMO JL. DR WAHIDIN N. 40, BOJONEGORO 08988686845

JL DR SOETOMO NO. 128 PADANGAN,

100 GALUH PUSPA RAHAYU, S.Farm, Apt. BOJONEGORO APOTEK MAJU JAYA FARMA _ 15061988014718
BOJONEGORO

: TIDAK BERPARTISIPASI DLM SEMINAR & RAKERCAB 12-DES-15

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007/13/DINKES/Apt./II/2012

19870611/STRA-UNAIR/2001/14944 16.4854/PP.IAI/VII/2011 440/2116/412.40/2008 013/13/DINKES/Apt./II/2012

19780611/STRA-UNAIR/2001/14944/25-11-2011 442/293/208.412/2012 003/13/DINKES/Apt./II/2012 12/29/2016

19780423/STRA-UBAYA/2001/217265 16.1075/PP.ISFI/VII/2007 440/643/208.412/2010 1/5/2016

19760914/STRA-UNAIR/2001/217281/14-09-2016 16.7259/PP.IAI/III/2013 018/13/DINKES/Apt./III/2012 9/14/2016

19821216/STRA-UBAYA/2008/224231 16.2573/PP/ISFI/VI/2008

19781228/STRA-UNAIR/2002/217292/30-11-2011 16.4864/PP.IAI/VII/2011 442/355/208.412/2012 004/13/DINKES/Apt./II/2012 4/23/2017

19830611/STRA-UBAYA/2008/217279 16.8648/PP.IAI/XII/2013

19861109/STRA-UNAIR/2010/217289 16.4156/PP/IAI/XI/2010

19821030/STRA-UNAIR/2006/210172/25-10-2011 16.4921/PP.IAI/VII/2014 442/785/208.412/2012 047/13/DINKES/Apt./VII/2012 9/18/2017

19820325/STRAUMP/2006/25243 147268/PP.IAI/I/2013

19860918/STRA-UNAIR/2009/215590 16.8683/PP.IAI/XII/2013
19821114/STRA-UBAYA/2007/224176/06-01-2012 16.0630/PP.ISFI/V/2007 442/634/208.412/2012 028/13/DINKES/Apt./III/2012 7/25/2017
19790213/SRTA-UWM/2004/217293 16.4873/PP.IAI/VII/2011 440/221/208.412/2011 005/13/DINKES/Apt./II/2012 2/24/2016

440/430/208.412/2010 10/6/2015

19880808/STRA-UD/2013/231933 0

032/13/DINKES/Apt./IV/2012

440/2443/412.40/2007
19820910/STRA-UII/2005/224235 16.5727/PP.IAI/IV/2012 023/13/DINKES/Apt./III/2012 9/17/2015

19870607/STRA-UNHAS/2011/224735 27.1250/PP.IAI/V/2011
440/496/208.412/2011
002/13/DINKES/Apt./II/2012

038/13/DINKES/Apt./V/2012
 440/685/208.412/2011 027/13/DINKES/Apt./III/2012

19860410/STRA-UAD/2012/17458/10-03-2012 42/857/208.412/2012 046/13/DINKES/Apt./VII/2012 10/5/2017

19880323/STRA-UBAYA/2011/215709/29-11-2011 16.5242/PP.IAI/XI/2011 442/547/208.412/2012 011/13/DINKES/Apt./II/2012 7/3/2017

19840921/STRA-UNAIR/2007/217262 16.6809/PP.IAI/XI/2012 440/144/208.412/2010 3/23/2015

19800329/STRA-UNTAG/2004/28323 11.0928/PP.IAI/II/2014

19860330/STRA-ISTN/2011/15882 12,6420/PP.IAI/XII/2011

19811213/STRA-UMS/2006/217278/30-11-2011 442/424/208.412/2012 021/13/DINKES/Apt./III/2012 6/6/2017

19730226/STRA-UNAIR/1997/224232 16.7403/PP.IAI/II/2013

19730415/STRA-UNAIR/1998/217260 16.2542/PP.ISFI/V/2008

440/583/208.412/2011 009/13/DINKES/Apt./II/2012
19830731/STRA-STIFAR-YPS/2010/11530 14.7848/PP.IAI/III/2013

440/1118/412.40/2007

10/7/2016

19880615/STRA-UBAYA/2011/231629 0
 NAMA LENGKAP & GELAR NAMA INSTANSI
NO
1 Dra. TITIK INDRAWATI, Apt. APOTEK INDRIA
2 ADINIA, S.Farm., Apt. APOTEK BAURENO FARMA
3 AGUNG TRIANJONO, S.Farm., Apt. RS MUNA ANGGITA
4 AJENG PERMATA ULFAH, S.Farm., Apt. APOTEK DANDER
5 ALHAMI SEPTININGRUM, S.Si., Apt. APOTEK EL
6 ANA NURLAILI HIDAYAH, S.Farm., Apt. APOTEK MAJU MAPAN FARMA
7 ANDRI HARMONO, S.Farm., Apt. APOTEK KEPOHBARU
RSUD DR R SOSODORO
8 ANINDYA RIZKY DEWANGGANI, S.Farm., Apt. DJATIKOESOEMO
9 ANITA FAJARWATI, S.Farm., Apt. APOTEK PENGKOK FARMA
10 ANITA RACHMAWATI, S.Farm., Apt., M.Kes. __
RSUD DR R SOSODORO
11 ARDHANI WIDYANINGRUM, S.Farm., Apt.
DJATIKOESOEMO
12 ARI ASTUTIK WULANDARI, S.Farm., Apt., APOTEK KEDUNGADEM
13 ARIFAH NURAINI, S.Si., Apt. APOTEK SIMPANG LIMA
14 ATIKA DIKAN ISNAWATI, S.Farm., Apt APOTEK COKRO MEDIKA
15 AYU BUDAYA, S.Farm., Apt. APOTEK TAJI
16 BELINDA ARBITYA DEWI, S.Farm., Apt. APOTEK KARUNIA
17 CHRISTINE FERLINA, S.Farm., Apt. APOTEK AZ-ZAHRO
18 DAMAYANTI VINA, S.Farm., Apt. APOTEK BUDI ASIH - PURWOSARI
19 DENI LYAWATI, S.Farm., Apt. APOTEK SEHAT KASIMAN
RSUD DR R SOSODORO
20 DEWI KARTIKA SARI, S.Farm., Apt. DJATIKOESOEMO
21 DIAN SETYA PUTRI, S.Farm., Apt. APOTEK KANOR FARMA
22 DITO GALIH PRASETYO, S.Far., Apt. APOTEK PURWOSARI FARMA
23 Dra. IRENE HELIANA DJAJA, Apt. APOTEK BHAKTI
24 Drs. ABDUL BAHRY, Apt. APOTEK CENDANA MITRA FARMA
25 Drs. MOHAMMAD IHSAN, M.Si., Apt. APOTEK PANGSUD
26 Drs. SUNDORO TANTO, Apt. APOTEK BINTANG
27 DWI AYU AGUSTINA, S.Farm., Apt. APOTEK DANDER
28 DWIANTO ADHI NUGROHO, S.Farm., Apt. APOTEK DWI GRAHA SUKSES
ALAMAT NO KTA NO STRA NO SERTIFIKAT KOMPENTENSI
JL. Dr. CIPTO NO. 129, BOJONEGORO
JL. RAYA PASINAN NO. 210, BAURENO, BOJONEGORO
19821027/STRA-UBAYA/2008/217620/30-11-2011
JL. AKBAR Gg. MELATI RT 33/ RW 02, BOJONEGORO
Dsn. PURWOREJO RT 22/ RW 04 Ds. KEPUNG,
KEPUNG, KEDIRI
JL. LETDA NURHASYIM NO. 456 KALIANYAR, KAPAS,
BOJONEGORO 19790920/STRA-UMD/2004/231880 16.7593/PP.IAI/VI/2013
JL. RAYA BOJONEGORO-CEPU NO. 20, PANJUNAN,
KALITIDU, BOJONEGORO 15031987025097 19870315/STRA-UNAIR/2010/224234 16.4144/PP.IAI/XI/2010
_
JL. MONGINSIDI KAMPUNG BARU Gg. 2 NO. 6,
BOJONEGORO
JL. DR. SUTOMO NO. 88 RT 21/RW 06, Dsn. PENGKOK,
PADANGAN, BOJONEGORO 1011983035449 0 0
JL. KH. HASYIM ASHARI NO. 23, BOJONEGORO
WISMA INDAH BARU BLOK F-4, BOJONEGORO
Dsn. MINDI RT 15/ RW 03 Ds. SUGIHWARAS,
SUGIHWARAS, BOJONEGORO
JL. BASUKI RAHMAD Gg. NAMLO NO. 30,
BOJONEGORO
Dsn. MEJASEM, RT 04/ RW 04, Ds. BAKUNG, KANOR,
BOJONEGORO 3081987025116 19870803/STRA-UNAIR/2011/222735 16.4628/PP.IAI/V/2011
PENGKOK RT 17/RW 05, PADANGAN, BOJONEGORO 25021984025123 19840225/STRA-USB/2009/25462 14.8238/PP.IAI/X/2013
PERUM PERMATA TLASEH, Gg. H. CHOZIN BLOK F NO.
80, DANDER, BOJONEGORO
WISMA INDAH BARU BLOK G NO. 69, BOJONEGORO
JL. TANJUNG NO. 43, PURWOSARI, BOJONEGORO
JL. WONOSARI, SAMBENG, RT 14/ RW 05, KASIMAN,
BOJONEGORO 14101983025109 19831014/STRA-STIFAR-YPS/2005/21635 0
JL. MH. THAMRIN Gg. NGALIMUN PERUMAHAN
THAMRIN INDAH REGENCY BLOK B-3, BOJONEGORO
Ds. SIWALAN RT 14/ RW 06, SUGIHWARAS,
BOJONEGORO 19910922/STRA-USB/2015/239757 0
JL. RAYA KALITIDU NO. 110 BOJONEGORO 19871007/STRA-ISTN/2011/15881 12.6387/PP.IAI/XII/2011
JL. JAKSA AGUNG SUPRAPTO NO. 232, BOJONEGORO 7081946009246 19460807/STRA-UGM/1973/217266/30-11-2011 16.5298/PP.IAI/XII/2011
JL. GUBENG KERTAJAYA 9C NO. 1, SURABAYA
19590921/STRA-UNAIR/1990/14964 16.1610/PP/ISFI/XI/2007
PERUMDA BLOK C-4, BOJONEGORO 3031963009253 19630303/STRA-UNAIR/1991/14943 16.4875/PP.IAI/VII/2011
JL. MH. THAMRIN NO.32, SURABAYA 22071966009266 19660722/STRA-UNAIR/1990/14950/25-11-2011 16.5356/PP.IAI/XII/2011
JL. RAYA DANDER NO. 68 RT 23/ RW O3, DANDER,
BOJONEGORO 0 19830811/STRA-USB/2009/222224 14.8258/PP.IAI/X/2013
JL. Dr. CIPTO NO. 129, BOJONEGORO 16091983025112 19830916/STRA-UBAYA/2011/14433 16.5188/PP.IAI/XI/2011
29 ELFINA DEWI SYANTI, S.Si., Apt. RS MUHAMMADIYAH KALITIDU
30 ENDAH WAHYUNINGSARI, S.Farm., Apt. APOTEK PARADIGMA
31 ENDRI AMPRIANI RAHAYU S.Farm.,Apt APOTEK TAMBAKREJO FARMA
32 ERIA FARIHA, S.Farm., Apt. APOTEK KITA
33 ERNA HARYATI, S.Si., Apt. APOTEK DIPONEGORO
34 EVA OETOMO, S.Si., Apt. APOTEK SINAR
35 FAIK FAUZI, S.Farm., Apt. APOTEK MULIA FARMA
RSUD DR R SOSODORO
36 FAIVA MURIANDINI, S.Si., Apt.
DJATIKOESOEMO
37 FARADINA ROSITA, S.Farm., Apt. APOTEK FARADINA
38 FEMMY SUGIANTO, S.Farm., Apt. APOTEK BETHEL
39 FETTY ZUBAIDHAH, S.Farm., Apt. APOTEK AL KHANZA
40 FITRI WULANSARI, S.Farm., Apt. APOTEK AVERA
98 FLORA ANITASARI, S.Farm., Apt. APOTEK BANJARSARI
41 FRANSISCA WIDIANINGRUM, S.Si, Apt. APOTEK SOLUSI SEHAT
42 FRANSISKUS RONY ISMANTO, S.Si., Apt. APOTEK TRIO SAHABAT
43 GRACE ARNICA HARJANTO, S.Si., Apt. APOTEK NUSA
44 HERYANTI PUSPARISA, S.Si., Apt. RS. WAHYU TUTUKO
45 HEVY ANDRIANI, S.Farm., Apt. APOTEK TUMBRAS - KEDUNGADEM JL. Dr. WAHIDIN NO. 2, BOJONEGORO
46 IKA INDRIAWATI, S.Si., Apt. APOTEK KEDUNG WARAS
47 INDAH YUNI SUSWANTI, S.Farm., Apt. APOTEK MANJUR - KEDUNGADEM
48 INDRIYANI, S.Si., Apt. APOTEK LANCAR FARMA
49 INNEKE DIAN RAHMA, S.Farm., Apt. APOTEK SALSABILA
50 IRMA HIDHAYATUL RAHMI, S.Farm., Apt. RSUD SUMBERREJO
51 ITA DIANITA WULANDARI, S.Farm., Apt. APOTEK MANJUR BALEN
52 KHOIRUL LUKMAN HAKIM, S.Farm., Apt. APOTEK RAZQA - BAURENO
53 KUKUH LESTARI, S.Farm., Apt. APOTEK PARAMEDINA
54 LENI KURNIAWATI, S.Farm., Apt. APOTEK PATOMAN
55 LINAWATI, S.Farm., Apt. APOTEK TUNGGAL
56 LUSI LIESAWATI, S.Si., Apt. APOTEK BUDI JAYA
57 MEI ANJAR KUSSUMA, S.Farm., Apt. APOTEK SEHAT
RS ISLAM MUHAMMADIYAH
58 MIMING ANTIKA DIESTANINGRUM, S.Farm., Apt. SUMBERREJO
59 MUHAMMAD KHALID RIJALUDDIN, S.Farm, Apt. APOTEK ASY SYIFA
JL. RAYA KALITIDU NO. 266 BOJONEGORO
JL. MASTRIP NO. 90, BOJONEGORO
Jl.Raya 06 Sukorejo Tambakrejo Bojonegoro
JL. RAYA RT 05/RW 01, SOBONTORO, BALEN,
BOJONEGORO 27011984025119 19840127/STRA-UNAIR/2008/224239 16.8175/PP.IAI/X/2013
JL. DIPONEGORO NO. 26A, BOJONEGORO 18101973009235 19731018/STRA-UNAIR/1999/217276 16.4413/PP/IAI/II/2012
JL. AKBP M. SUROKO NO. 18, BOJONEGORO 11021979000237 19790211/STRA-UBAYA/2002/217274 16.6096/PP.IAI/VI/2012
JL. RAYA KALITIDU NO. 110 BOJONEGORO
PERUMDA BLOK B-22, BOJONEGORO
JL. TEUKU UMARNO. 79A, BOJONEGORO
JL. DIPONEGORO NO. 86, BOJONEGORO 24041984009240 19840424/STRA-UBAYA/2007/217290 16.0713/PP.ISFI/V/2007
JL. MONGINSIDI III/3 SUKOREJO, BOJONEGORO 1051983025118 19830501/STRA-UMS/2007/233078/23-12-2011 140093/PP.IAI/X/2014
SEMAMPIR RENGAH 4 NO. 5, SURABAYA 22081981009241 19810822/STRA-UBAYA/2006/217270 16.5285/PP.IAI/XII/2011
TOKO MANDALA JL. DIPONEGORO, BOJONEGORO
JL. M.H. THAMRIN NO. 103D, BOJONEGORO 62100 11061978009244 19870611/STRA-UNAIR/2001/14944 16.4854/PP.IAI/VII/2011
JL. WR SUPRATMAN NO. 2A, BOJONEGORO
19780611/STRA-UNAIR/2001/14944/25-11-2011
JL. JAKSA AGUNG SUPRAPTO NO. 232, BOJONEGORO 23041978009245 19780423/STRA-UBAYA/2001/217265 16.1075/PP.ISFI/VII/2007
WISMA INDAH BARU BLOK G NO. 64, BOJONEGORO 14091976009246 19760914/STRA-UNAIR/2001/217281/14-09-2016 16.7259/PP.IAI/III/2013
18121982025139 19821216/STRA-UBAYA/2008/224231 16.2573/PP/ISFI/VI/2008
JL. WR SUPRATMAN NO. 2A, BOJONEGORO 28121987009247 19781228/STRA-UNAIR/2002/217292/30-11-2011 16.4864/PP.IAI/VII/2011
TOSERBA JL. RAYA KEDUNGADEM, BOJONEGORO 11061983009248 19830611/STRA-UBAYA/2008/217279 16.8648/PP.IAI/XII/2013
JL. RAYA NO. 150 SUMURAGUNG, SUMBERREJO,
BOJONEGORO
JL. GAJAH MADA BOK B3- B4, BOJONEGORO
PACUL PERMAI BLOK G-1, BOJONEGORO 62114 9111986009250 19861109/STRA-UNAIR/2010/217289 16.4156/PP/IAI/XI/2010
JL. MH. THAMRIN Gg. MAWAR NO. 3 BOJONEGORO 30101982025111 19821030/STRA-UNAIR/2006/210172/25-10-2011 16.4921/PP.IAI/VII/2014
JL. RAYA BAURENO NO. 227, BAURENO, BOJONEGORO
JL. RAJEKWESI NO. 62 RT 01/ RW 01 Ds. TAPELAN,
KAPAS, BOJONEGORO 25031982028938/1 19820325/STRAUMP/2006/25243 147268/PP.IAI/I/2013
Ds. SEMBUNG LOR RT 07/ RW 04, BAURENO,
BOJONEGORO 18091986025142 19860918/STRA-UNAIR/2009/215590 16.8683/PP.IAI/XII/2013
JL. VETERAN NO. 120, BOJONEGORO 141119821290311 19821114/STRA-UBAYA/2007/224176/06-01-2012 16.0630/PP.ISFI/V/2007
JL. Dr. CIPTO NO. 53A, BOJONEGORO 13021979009252 19790213/SRTA-UWM/2004/217293 16.4873/PP.IAI/VII/2011
JL. KLAMPIS SEMOLO BARAT J-33, SURABAYA
JL. DR. SUHARSO NO.19, BOJONEGORO
JL. RAYA KEDUNGADEM Ds. BANJAREJO, POHWATES,
BOJONEGORO
 BADUG RT 02/ RW 03, SUMURAGUNG, SUMBERREJO,
60 MUMAYA ZAUHARA, S.Farm., Apt. APOTEK MUMAYA FARMA BOJONEGORO
KLINIK RAWAT INAP JL. RAYA NDROKILO, Ds. NDROKILO, KEDUNGADEM,
61 NELLY FRONIKA SITUMORANG, S.Farm., Apt. MUHAMMADIYAH KEDUNGADEM BOJONEGORO 8081988025131 19880808/STRA-UD/2013/231933 0

62 NILUH INDRAWATI, S.Farm., Apt. APOTEK GLORY JL. KS TUBUN NO. 33, BOJONEGORO

JL. DR. SUTOMO NO.204 PASINAN, BAURENO,

63 NOVI HIDAYAH, S.Farm., Apt. APOTEK WARDOYO BOJONEGORO

64 NOVITRI WULANDARI, S.Farm., Apt. RS. 'AISYIYAH BOJONEGORO JL. HASYIM ASY’ARI NO. 17 BOJONEGORO

JL. DAHLIA NO. 11, WISMA INDAH TENGAH,

65 NUR ENDAH PURNOMO, S.Farm., Apt. APOTEK JOGLO BOJONEGORO 10091982025138 19820910/STRA-UII/2005/224235 16.5727/PP.IAI/IV/2012

66 NUR IHSANI YUSUF, S.Si., Apt APOTEK PRIMA FARMA JL. KI HAJAR DEWANTARA NO. 20, BOJONEGORO 7061987025048 19870607/STRA-UNHAS/2011/224735 27.1250/PP.IAI/V/2011

67 NUR SUKMO SUDARMONO, S.Si., Apt. APOTEK EKA SUGIHWARAS JL. RAYA KAPAS NO. 89, KAPAS, BOJONEGORO

Ds. CANGA'AN NO. 93 RT 02/RW 01, KANOR,

68 NURUL MA'RIFAH, S.Farm., Apt. APOTK DMC - DANDER BOJONEGORO

69 PRATIDINA ARADHANI, S.Farm., Apt. APOTEK BOJONEGORO JL. PANGLIMA SUDIRMAN NO. 2, BOJONEGORO

RSUD DR R SOSODORO JL. LETTU SUWOLO Gg. PRIBADI BLOK A,

70 PUJI RAHAYU, S.Si., Apt. DJATIKOESOEMO BOJONEGORO
71 RAMADHAN BAYUMURTHY, S.Far., Apt. APOTEK EBA MEDIKA FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO

72 RATNA WULANDARI, S.Farm., Apt. APOTEK KENZIE FARMA JL. RAYA CEPU NO. 6, KALITIDU, BOJONEGORO

97 RHANUGA HARMUSYANTO, S.Farm., Apt. APOTEK SEHAT BAROKAH JL. RAYA SOBONTORO NO. 123, BALEN
PERUM GRAHA INDAH RUKO B-7 TIKUNG,
73 RIBUT TIRTAYANA, S.Farm., Apt. RSUD PADANGAN LAMONGAN

74 RIKA WAHYULI , S.Farm., Apt. APOTEK BASUKI RAHMAD JL. BASUKI RAHMAD NO. 3, BOJONEGORO

75 ROBBY NAJINI, S.Farm., Apt APOTEK PRAPATAN FARMA JL. RAYA KALITIDU NO. 110 BOJONEGORO
JL. DR. SUTOMO NO. 166 RT 21/ RW O6, PADANGAN,
76 ROHKIYAT, S.Far., Apt. APOTEK NGRAHO FARMA BOJONEGORO 19860410/STRA-UAD/2012/17458/10-03-2012
JL. RAYA SUMBERREJO NO. 1180, SUMBERREJO,
77 RONALD HADI WIJAYA, S.Farm., Apt. APOTEK RIDHO SEHAT BOJONEGORO

78 SELVI DARIANTI, S.Farm., Apt. APOTEK SUMBER WARAS JL. SERMA MAUN BARAT NO. 87, BOJONEGORO 23031988028843 19880323/STRA-UBAYA/2011/215709/29-11-2011 16.5242/PP.IAI/XI/2011

79 SEPTY MARTHA SARI, S.Farm., Apt. APOTEK K-24 ADIPURA JL. BRIGJEN SUTOYO N0. 17, BOJONEGORO 21091984025117 19840921/STRA-UNAIR/2007/217262 16.6809/PP.IAI/XI/2012
JL. SURABAYA-CEPU NO. 39, KORGAN, PURWOSARI,
80 SETYO PUTRI PUJI LESTARI SUDJONO, S.Farm., Apt. APOTEK TOBO FARMA BOJONEGORO
JL. P. POLIM Gg. MANGGA III LORONG IV BLOK D3,
81 SISCA HARNAYANTI, S.Farm., Apt. APOTEK SYIFA FARMA BOJONEGORO 29031980025012 19800329/STRA-UNTAG/2004/28323 11.0928/PP.IAI/II/2014

### SISWONO HANDOKO JATI, S. Farm., Apt. APOTEK TIRTA FARMA JL. COKROAMINOTO, DANDER, BOJONEGORO 30031986028227 19860330/STRA-ISTN/2011/15882 12,6420/PP.IAI/XII/2011

82 SOFI NUR ASLAMY, S.Farm., Apt. RS. 'AISYIYAH BOJONEGORO JL. HASYIM ASY’ARI NO. 17 BOJONEGORO

83 SOFYAN AGUS CHRISTANTO, S.Farm., Apt. APOTEK PELANGI KASIH JL. JAKSA AGUNG SUPRAPTO NO. 155, BOJONEGORO

84 SRI WURYANI, S.Farm., Apt. APOTEK PADANGAN JL. DIPONEGORO NO. 165, PADANGAN, BOJONEGORO
19811213/STRA-UMS/2006/217278/30-11-2011

85 SUNARTI, M.Sc., Apt. APOTEK GARAS PERUM GRIYA CENDANA NO. 14, SAWAHAN RT 03/
RW 02, NGEMPLAK, BOYOLALI

86 TIRTO AMBORO, S.Farm., Apt. APOTEK GLOBAL 556 JL. AIRLANGGA NO. 39, SURABAYA

87 TITI AGNI HUTAHAEN, S.Farm., M.Farm. Klin., Apt. RS. IBNU SINA NGRASEH RT 15/ RW O3, DANDER, BOJONEGORO

88 UMI HANIK, S.Si., Apt. RS. 'AISYIYAH BOJONEGORO JL. HASANUDIN NO. 71, BOJONEGORO 26021973025048 19730226/STRA-UNAIR/1997/224232 16.7403/PP.IAI/II/2013
89 UNGGUL ADIGUNO, S.Si., Apt. APOTEK KU JL. BOJONEGORO - DANDER NO. 489, BOJONEGORO

90 WINDAH EKA HARDINI, S.Farm., Apt. APOTEK ANITA FARMA SEMOLOWARU SELATAN 5/15, SURABAYA

91 WIWIK WIDYAWATI, S.Farm., Apt. APOTEK SUMBER BAHAGIA JL. LETTU SUWOLO NO. 121, BOJONEGORO 15041973009269 19730415/STRA-UNAIR/1998/217260 16.2542/PP.ISFI/V/2008
99 YESSICA IKA DEWI TIRTA AYU SPA
92 YOUSTIANA DWI RUSITA, S.Farm., M.Si., Apt. APOTEK ALIFIA JL. J.A. SUPRAPTO NO. 21, BOJONEGORO
93 YULI SETIYANTO, S.Farm., Apt. RSI PEMUDA JL. PEMUDA NO. 29, BOJONEGORO 31071983025140 19830731/STRA-STIFAR-YPS/2010/11530 14.7848/PP.IAI/III/2013

94 YUNITA SARI NUR HIDAYAH, S.Farm., Apt. APOTEK SROYO SIDODADI LR.2 NO. 7, RT 01/ RW 06, CEPU, BLORA

95 YUSITA INDRASTIWI, S.Farm., Apt. KLINIK ANS KALITIDU PERUM. NDORO ASRI, KARANG BOYO, CEPU

RSUD DR R SOSODORO
96 ZAINUL ARIFIN, S.Si., Apt. JL. DR WAHIDIN N. 40, BOJONEGORO
DJATIKOESOEMO

### GALUH PUSPA RAHAYU, S.Farm, Apt. APOTEK MAJU JAYA FARMA JL DR SOETOMO NO. 128 PADANGAN, BOJONEGORO 15061988014718 19880615/STRA-UBAYA/2011/231629 0

: TIDAK BERPARTISIPASI DLM SEMINAR & RAKERCAB 12-DES-15