Provider Demographics
NPI:1376107508
Name:MILDENBERGER, JAMES ARTHUR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:MILDENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:ARTHUR
Other - Last Name:MILDENBERGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1308 S 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4427
Mailing Address - Country:US
Mailing Address - Phone:970-522-4516
Mailing Address - Fax:
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9095
Practice Address - Country:US
Practice Address - Phone:970-522-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist