Provider Demographics
NPI:1336825629
Name:MUSSLER, WILLIAM (DPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MUSSLER
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S WASHITA ST
Mailing Address - Street 2:
Mailing Address - City:WETUMKA
Mailing Address - State:OK
Mailing Address - Zip Code:74883-5522
Mailing Address - Country:US
Mailing Address - Phone:405-452-1313
Mailing Address - Fax:
Practice Address - Street 1:325 S WASHITA ST
Practice Address - Street 2:
Practice Address - City:WETUMKA
Practice Address - State:OK
Practice Address - Zip Code:74883-5522
Practice Address - Country:US
Practice Address - Phone:405-452-1313
Practice Address - Fax:405-452-3872
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016221A3336C0002X
OK153493336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy