Provider Demographics
NPI:1962499665
Name:BRESLOW, ROBERT MENDEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MENDEL
Last Name:BRESLOW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
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Mailing Address - Street 1:4560 GOLDMINE RD
Mailing Address - Street 2:
Mailing Address - City:DODGEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53533-8917
Mailing Address - Country:US
Mailing Address - Phone:608-935-5717
Mailing Address - Fax:608-265-5421
Practice Address - Street 1:777 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2222
Practice Address - Country:US
Practice Address - Phone:608-262-1416
Practice Address - Fax:608-262-3397
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI90051835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy