Provider Demographics
NPI:1194862045
Name:MULDER, RUTH ANTONETTE (RPH)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANTONETTE
Last Name:MULDER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8521 WYTHMERE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2510
Mailing Address - Country:US
Mailing Address - Phone:407-739-1861
Mailing Address - Fax:407-290-5252
Practice Address - Street 1:8815 CONROY WINDERMERE RD
Practice Address - Street 2:#351
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3129
Practice Address - Country:US
Practice Address - Phone:407-739-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 30016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist