Provider Demographics
NPI:1013346535
Name:LABELLO, ROBERT JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LABELLO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 HIGHWAY 175
Mailing Address - Street 2:
Mailing Address - City:HUBERTUS
Mailing Address - State:WI
Mailing Address - Zip Code:53033-9304
Mailing Address - Country:US
Mailing Address - Phone:262-628-3550
Mailing Address - Fax:262-628-9205
Practice Address - Street 1:1303 HIGHWAY 175
Practice Address - Street 2:
Practice Address - City:HUBERTUS
Practice Address - State:WI
Practice Address - Zip Code:53033-9304
Practice Address - Country:US
Practice Address - Phone:262-628-3550
Practice Address - Fax:262-628-9205
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16219-040183500000X
IL051-033514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist