Healthcare Provider Details

I. General information

NPI: 1285739136
Provider Name (Legal Business Name): RICHARD D. MULDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N OAKLAND AVE
OAKLAND NE
68045-1132
US

IV. Provider business mailing address

301 N OAKLAND AVE
OAKLAND NE
68045-1132
US

V. Phone/Fax

Practice location:
  • Phone: 402-685-5883
  • Fax: 402-685-5173
Mailing address:
  • Phone: 402-685-5883
  • Fax: 402-685-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10882
License Number StateNE

VIII. Authorized Official

Name: MR. RICHARD DEAN MULDER
Title or Position: OWNER
Credential: RPH
Phone: 402-685-5883