Provider Demographics
NPI:1023382330
Name:MULLENIX, CANDY LYNNETTE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:LYNNETTE
Last Name:MULLENIX
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:PO BOX 803
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-0803
Mailing Address - Country:US
Mailing Address - Phone:803-786-8110
Mailing Address - Fax:
Practice Address - Street 1:420 MCNULTY ST
Practice Address - Street 2:SUITE B
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8926
Practice Address - Country:US
Practice Address - Phone:803-786-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6700183500000X
IA16157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist