Provider Demographics
NPI:1366613812
Name:MUEHLBAUER, CARL DENNIS
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:DENNIS
Last Name:MUEHLBAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-7603
Mailing Address - Country:US
Mailing Address - Phone:570-857-1428
Mailing Address - Fax:
Practice Address - Street 1:RT 6 590 PALMRYA TOWNSHIP
Practice Address - Street 2:LAKE REGIONAL CENTER
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428
Practice Address - Country:US
Practice Address - Phone:570-226-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist