Provider Demographics
NPI:1942646849
Name:MAUTHE, RICHARD ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANTHONY
Last Name:MAUTHE
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 1:5401 W INTEGRITY WAY
Mailing Address - Street 2:
Mailing Address - City:GRAND CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8602
Mailing Address - Country:US
Mailing Address - Phone:920-363-7010
Mailing Address - Fax:920-363-7001
Practice Address - Street 1:5401 W. INTEGRITY WAY
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-363-7010
Practice Address - Fax:920-363-7001
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10195-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist