Provider Demographics
NPI:1063503225
Name:THE MUECKE COMPANY INC
Entity Type:Organization
Organization Name:THE MUECKE COMPANY INC
Other - Org Name:HIBBS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUECKE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:979-245-9006
Mailing Address - Street 1:1415 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77414
Mailing Address - Country:US
Mailing Address - Phone:979-245-5501
Mailing Address - Fax:979-245-9006
Practice Address - Street 1:1415 AVENUE G
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-3505
Practice Address - Country:US
Practice Address - Phone:979-245-5501
Practice Address - Fax:979-245-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34547332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX013761401Medicaid
TX013761401Medicaid