Provider Demographics
NPI:1649413436
Name:HENGEHOLD, ROBERT B (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:B
Last Name:HENGEHOLD
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 1:37165 GROESBECK HWY
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036
Mailing Address - Country:US
Mailing Address - Phone:586-468-1428
Mailing Address - Fax:586-468-8929
Practice Address - Street 1:37165 GROESBECK HWY.
Practice Address - Street 2:
Practice Address - City:CLINTON TWP.
Practice Address - State:MI
Practice Address - Zip Code:48036
Practice Address - Country:US
Practice Address - Phone:586-468-1428
Practice Address - Fax:586-468-8929
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302022502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist