Provider Demographics
NPI:1255503397
Name:MULLVAIN, RICHARD D (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:MULLVAIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 3RD ST
Mailing Address - Street 2:HEART CENTER MAIL DROP (SM3HC2)
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1950
Mailing Address - Country:US
Mailing Address - Phone:218-786-5581
Mailing Address - Fax:218-720-4633
Practice Address - Street 1:407 E 3RD ST
Practice Address - Street 2:HEART CENTER MAIL DROP (SM3HC2)
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1950
Practice Address - Country:US
Practice Address - Phone:218-786-5581
Practice Address - Fax:218-720-4633
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12486-040183500000X
MN1154591835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist