Provider Demographics
NPI:1841522182
Name:CHI, MILDRED MUYANG (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:MUYANG
Last Name:CHI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MILDRED
Other - Middle Name:MUYANG
Other - Last Name:NDANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1100 HIGHWAY 10 WEST
Mailing Address - Street 2:KMART PHARMACY #3897
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-6235
Mailing Address - Country:US
Mailing Address - Phone:763-427-7699
Mailing Address - Fax:763-712-8314
Practice Address - Street 1:1100 W HIGHWAY 10 NW
Practice Address - Street 2:KMART PHARMACY#3897
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2086
Practice Address - Country:US
Practice Address - Phone:763-427-7699
Practice Address - Fax:763-712-8314
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist