Provider Demographics
NPI:1851434054
Name:ROHDE, GREGORY PAUL (RPH)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PAUL
Last Name:ROHDE
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 1:934 MICHIGAN STREET
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1849
Mailing Address - Country:US
Mailing Address - Phone:920-743-4814
Mailing Address - Fax:920-746-2962
Practice Address - Street 1:1300 EGG HARBOR ROAD
Practice Address - Street 2:SUITE 112
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1248
Practice Address - Country:US
Practice Address - Phone:920-746-2977
Practice Address - Fax:920-746-2962
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33127300Medicaid
WI0248310002Medicare ID - Type Unspecified