Provider Demographics
NPI:1366728941
Name:HAMILTON, ROBERT L
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HAMILTON
Suffix:
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 1:1041 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1616
Mailing Address - Country:US
Mailing Address - Phone:262-472-0238
Mailing Address - Fax:262-472-0294
Practice Address - Street 1:1041 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1616
Practice Address - Country:US
Practice Address - Phone:262-472-0238
Practice Address - Fax:262-472-0294
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10453-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist