Provider Demographics
NPI:1871707141
Name:ATKINSON, ROBERT J (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:ATKINSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1975
Mailing Address - Country:US
Mailing Address - Phone:920-499-4057
Mailing Address - Fax:920-592-8683
Practice Address - Street 1:1478 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-1975
Practice Address - Country:US
Practice Address - Phone:920-499-4057
Practice Address - Fax:920-592-8683
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7926040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist