Provider Demographics
NPI:1013222819
Name:REKOSKE, ROBERT D (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:REKOSKE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W153N10356 ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5221
Mailing Address - Country:US
Mailing Address - Phone:262-253-1211
Mailing Address - Fax:
Practice Address - Street 1:N78W14501 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4382
Practice Address - Country:US
Practice Address - Phone:262-255-8673
Practice Address - Fax:262-255-8678
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist