Provider Demographics
NPI:1669074712
Name:MUJKIC, EMIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EMIN
Middle Name:
Last Name:MUJKIC
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5376
Mailing Address - Country:US
Mailing Address - Phone:260-804-0746
Mailing Address - Fax:
Practice Address - Street 1:2501 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-6500
Practice Address - Country:US
Practice Address - Phone:574-269-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26028939A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist