Provider Demographics
NPI:1720089154
Name:OHLAU, ROBERT G SR (BS PHARMACY)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:G
Last Name:OHLAU
Suffix:SR
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 SW EAGLEGLEN PL
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7165
Mailing Address - Country:US
Mailing Address - Phone:772-220-4371
Mailing Address - Fax:
Practice Address - Street 1:1860 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4828
Practice Address - Country:US
Practice Address - Phone:772-467-3578
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist