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General NPI Number Information
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NPI Number | 1902365935
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Entity Type | Individual
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Provider Name | ROBERT RAYMOND PERTHEL
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 1721 SAEMANN AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-2342
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Country | US
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Telephone | 920-395-2980
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Fax |
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Provider Business Mailing Address
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Address Line | W160N10822 HIDDEN GLEN LN
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City | GERMANTOWN
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State | WI
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Zip | 53022-5547
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10753-40
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License Number State | WI
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