Healthcare Provider Details

I. General information

NPI: 1720089154
Provider Name (Legal Business Name): ROBERT G OHLAU SR. B.S. PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N LAWNWOOD CIR
FORT PIERCE FL
34950-4828
US

IV. Provider business mailing address

1382 SW EAGLEGLEN PL
STUART FL
34997-7165
US

V. Phone/Fax

Practice location:
  • Phone: 772-467-3578
  • Fax:
Mailing address:
  • Phone: 772-220-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS23502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: