Provider Demographics
NPI:1376661173
Name:MUELLER, RICHARD ALAN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:MUELLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-1633
Mailing Address - Country:US
Mailing Address - Phone:507-553-3161
Mailing Address - Fax:507-553-3914
Practice Address - Street 1:36 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1633
Practice Address - Country:US
Practice Address - Phone:507-553-3161
Practice Address - Fax:507-553-3914
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111797183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0401270001Medicare ID - Type Unspecified