Provider Demographics
NPI:1164790614
Name:MUILENBURG, JOHN WILLIAMS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAMS
Last Name:MUILENBURG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 WEST FREEPORT STREET
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012
Mailing Address - Country:US
Mailing Address - Phone:918-906-0454
Mailing Address - Fax:
Practice Address - Street 1:7111 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5402
Practice Address - Country:US
Practice Address - Phone:918-481-0666
Practice Address - Fax:918-481-1296
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist