Provider Demographics
NPI:1124330287
Name:MUELLER, ANNETTE L (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 STONEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-4220
Mailing Address - Country:US
Mailing Address - Phone:618-655-1649
Mailing Address - Fax:
Practice Address - Street 1:1603 STONEBROOKE DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-4220
Practice Address - Country:US
Practice Address - Phone:618-655-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051037483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist