Provider Demographics
NPI:1740613868
Name:MUCHA, ROBERT EDMUND (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDMUND
Last Name:MUCHA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2437
Mailing Address - Country:US
Mailing Address - Phone:262-375-0016
Mailing Address - Fax:
Practice Address - Street 1:1771 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2437
Practice Address - Country:US
Practice Address - Phone:262-375-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10888-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist