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General NPI Number Information
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NPI Number | 1114047487
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Entity Type | Individual
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Provider Name | BRIAN JAMES MULDER RPH
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2373 64TH ST SW SUITE 1100
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City | BYRON CENTER
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State | MI
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Zip | 49315-9400
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Country | US
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Telephone | 616-643-3950
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Fax | 616-249-0850
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Provider Business Mailing Address
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Address Line | 7028 ROSEWOOD CT
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City | HUDSONVILLE
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State | MI
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Zip | 49426-8832
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Country | US
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Telephone | 616-662-6202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302029856
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License Number State | MI
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