Provider Demographics
NPI:1457898165
Name:ROHDE, MARK A (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
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 1:211 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-1425
Mailing Address - Country:US
Mailing Address - Phone:906-341-5494
Mailing Address - Fax:906-341-6752
Practice Address - Street 1:211 S CEDAR STREET
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854
Practice Address - Country:US
Practice Address - Phone:906-341-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302-023639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist