Provider Demographics
NPI:1285739136
Name:RICHARD D. MULDER
Entity type:Organization
Organization Name:RICHARD D. MULDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:402-685-5883
Mailing Address - Street 1:301 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68045-1132
Mailing Address - Country:US
Mailing Address - Phone:402-685-5883
Mailing Address - Fax:402-685-5173
Practice Address - Street 1:301 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:NE
Practice Address - Zip Code:68045-1132
Practice Address - Country:US
Practice Address - Phone:402-685-5883
Practice Address - Fax:402-685-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1285739136Medicaid
NE5808870001Medicare NSC