Provider Demographics
NPI:1255869400
Name:MUELLNER, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MUELLNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 PEPPERELL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6100
Mailing Address - Country:US
Mailing Address - Phone:334-745-9356
Mailing Address - Fax:334-745-9352
Practice Address - Street 1:2900 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6100
Practice Address - Country:US
Practice Address - Phone:334-745-9356
Practice Address - Fax:334-745-9352
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist