=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073126082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY MUELLER PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 12/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3520 FOREST RD STE 1-350
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48910-3720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-318-0213
-----------------------------------------------------
Fax | 517-318-0214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42235 MAC RAE DR
-----------------------------------------------------
City | STERLING HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48313-2567
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-864-3379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302412732
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------