Healthcare Provider Details

I. General information

NPI: 1831453844
Provider Name (Legal Business Name): MR. BRIAN ROBERT MULLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 N 45TH ST
SEATTLE WA
98103-6803
US

IV. Provider business mailing address

510 SUMNER AVE
ABERDEEN WA
98520-3342
US

V. Phone/Fax

Practice location:
  • Phone: 206-632-3314
  • Fax: 206-545-8154
Mailing address:
  • Phone: 360-500-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60645271
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR60233273
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: