Healthcare Provider Details

I. General information

NPI: 1619089521
Provider Name (Legal Business Name): MUECKE COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 7TH ST
BAY CITY TX
77414-5306
US

IV. Provider business mailing address

2808 7TH ST
BAY CITY TX
77414-5306
US

V. Phone/Fax

Practice location:
  • Phone: 979-244-1772
  • Fax: 979-244-1498
Mailing address:
  • Phone: 979-244-1772
  • Fax: 979-244-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number4204
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MUECKE
Title or Position: OWNER
Credential: RPH
Phone: 979-244-1772