Individual
PETER HAYDEN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
401 E GREEN BAY ST, SHAWANO, WI 54166-2541
(715) 524-5600
(715) 524-5050
Mailing address
W5745 ERIC CT, PLYMOUTH, WI 53073-3521
(920) 207-7677
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
21034-40
WI
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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