Provider Demographics
NPI:1023155124
Name:MULLEN, RICHARD WALTER (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WALTER
Last Name:MULLEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WI
Mailing Address - Zip Code:53563-8405
Mailing Address - Country:US
Mailing Address - Phone:608-868-6463
Mailing Address - Fax:
Practice Address - Street 1:725 S JANESVILLE ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WI
Practice Address - Zip Code:53563-1775
Practice Address - Country:US
Practice Address - Phone:608-868-6777
Practice Address - Fax:608-868-4177
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12919183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist