MEDICARE: MR. ROBERT G OHLAU SR. B.S. PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS23502	FL

General Provider Information

NPI Number	:	1720089154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT G OHLAU SR. B.S. PHARMACY

Provider Business Mailing Address
First Line	:	1382 SW EAGLEGLEN PL
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-7165
Country	:	US
Telephone Number	:	772-220-4371
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 N LAWNWOOD CIR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4828
Country	:	US
Telephone Number	:	772-467-3578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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