Provider Demographics
NPI:1073670014
Name:MULLANEY MEDICAL INC
Entity Type:Organization
Organization Name:MULLANEY MEDICAL INC
Other - Org Name:MULLANEYS LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-587-6201
Mailing Address - Street 1:6096 MONTGOMERY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1618
Mailing Address - Country:US
Mailing Address - Phone:513-587-6202
Mailing Address - Fax:513-587-7650
Practice Address - Street 1:6096 MONTGOMERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-1618
Practice Address - Country:US
Practice Address - Phone:513-587-6202
Practice Address - Fax:513-587-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BX2000X, 333600000X, 3336C0003X, 3336C0004X
OH0216206003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2080487OtherPK
OH2684108Medicaid