Provider Demographics
NPI:1194087551
Name:MUELLER, STEPHEN MICHAEL (MS, RPH)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:MUELLER
Suffix:
Gender:M
Credentials:MS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3858 LAKE STREET, SUITE #5
Mailing Address - Street 2:LAKESIDE MALL
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603
Mailing Address - Country:US
Mailing Address - Phone:907-235-7760
Mailing Address - Fax:
Practice Address - Street 1:3858 LAKE STREET, SUITE #5
Practice Address - Street 2:LAKESIDE MALL
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603
Practice Address - Country:US
Practice Address - Phone:907-235-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1752183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist