=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194862045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH ANTONETTE MULDER RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8815 CONROY WINDERMERE RD #351
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-1861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8521 WYTHMERE LN
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-2510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-1861
-----------------------------------------------------
Fax | 407-290-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS 30016
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------