Provider Demographics
NPI:1407132467
Name:SPITZMUELLER, MARK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SPITZMUELLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2906
Mailing Address - Country:US
Mailing Address - Phone:763-566-8350
Mailing Address - Fax:
Practice Address - Street 1:7700 BROOKLYN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2906
Practice Address - Country:US
Practice Address - Phone:763-566-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist