Provider Demographics
NPI:1447888151
Name:MUELLER, JONATHAN PETER (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PETER
Last Name:MUELLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CENTRAL BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2944
Mailing Address - Country:US
Mailing Address - Phone:715-842-0744
Mailing Address - Fax:715-842-0774
Practice Address - Street 1:102 CENTRAL BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2944
Practice Address - Country:US
Practice Address - Phone:715-842-0744
Practice Address - Fax:715-842-0774
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist