Provider Demographics
NPI:1295015782
Name:PRELESNIK, ROBERT D (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:PRELESNIK
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 1:510 N BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1150
Mailing Address - Country:US
Mailing Address - Phone:616-950-9613
Mailing Address - Fax:616-850-9708
Practice Address - Street 1:510 N BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1150
Practice Address - Country:US
Practice Address - Phone:616-950-9613
Practice Address - Fax:616-850-9708
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist