Provider Demographics
NPI:1326320664
Name:MULVANEY, MARK BERNARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BERNARD
Last Name:MULVANEY
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 1:1959 NE PACIFIC ST
Mailing Address - Street 2:BOX 356015
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6015
Mailing Address - Country:US
Mailing Address - Phone:206-598-6060
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:BOX 356015
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6015
Practice Address - Country:US
Practice Address - Phone:206-598-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH600187911835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist