Provider Demographics
NPI:1033387089
Name:REBHOLZ, ROBERT J (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:REBHOLZ
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1111
Mailing Address - Country:US
Mailing Address - Phone:716-885-9944
Mailing Address - Fax:
Practice Address - Street 1:1410 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1111
Practice Address - Country:US
Practice Address - Phone:716-885-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048169-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist