Healthcare Provider Details

I. General information

NPI: 1588057764
Provider Name (Legal Business Name): MR. ROBIN B UJOODHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CLARE RD
ONTARIO OH
44906-1363
US

IV. Provider business mailing address

231 CLARE RD
ONTARIO OH
44906-1363
US

V. Phone/Fax

Practice location:
  • Phone: 419-529-2707
  • Fax:
Mailing address:
  • Phone: 419-529-2707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06216631
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS51693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: