Provider Demographics
NPI:1558639195
Name:WOOD, ROBERT L (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:WOOD
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 1:2702 CALUMET DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3835
Mailing Address - Country:US
Mailing Address - Phone:920-457-5656
Mailing Address - Fax:920-457-1731
Practice Address - Street 1:2702 CALUMET DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3835
Practice Address - Country:US
Practice Address - Phone:920-457-5656
Practice Address - Fax:920-457-1731
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9056-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist