Healthcare Provider Details

I. General information

NPI: 1023155124
Provider Name (Legal Business Name): RICHARD WALTER MULLEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S JANESVILLE ST
MILTON WI
53563-1775
US

IV. Provider business mailing address

5054 WALNUT GROVE RD
MILTON WI
53563-8405
US

V. Phone/Fax

Practice location:
  • Phone: 608-868-6777
  • Fax: 608-868-4177
Mailing address:
  • Phone: 608-868-6463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12919
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: