Most Relevant Information
Provider Data
| NPI Number: | 1003589946 |
| Provider Name: | PETER HAYDEN ROTH PHARMD |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 21034-40 |
Most Important Dates
| Enumeration Date: | 07/27/2021 |
| Last Updated: | 07/27/2021 |
Provider Practice Location
401 E GREEN BAY ST
SHAWANO
WI
541662541
Practice Location Phone/Fax
| Phone: | 7155245600 |
| Fax: | 7155245050 |
Provider Mailing Location
W5745 ERIC CT
PLYMOUTH
WI
530733521
Provider Mailing Phone/Fax
| Phone: | 9202077677 |
| Fax: |