Provider Demographics
NPI:1942487020
Name:WIND, ROBERT K
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:WIND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4024
Mailing Address - Country:US
Mailing Address - Phone:518-785-8086
Mailing Address - Fax:518-785-0680
Practice Address - Street 1:584 LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4024
Practice Address - Country:US
Practice Address - Phone:518-785-8086
Practice Address - Fax:518-785-0680
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist