Provider Demographics
NPI:1285641415
Name:MULL, DAVID LANIER (R PH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LANIER
Last Name:MULL
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 MERTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3006
Mailing Address - Country:US
Mailing Address - Phone:404-347-8121
Mailing Address - Fax:404-347-8121
Practice Address - Street 1:1700 MONROE DR NE
Practice Address - Street 2:KROGER PHARMACY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5033
Practice Address - Country:US
Practice Address - Phone:404-872-0785
Practice Address - Fax:404-873-7063
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist