Provider Demographics
NPI:1326692690
Name:MCNULTY, MITCHELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MCNULTY
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 1:1101 73RD ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1313
Mailing Address - Country:US
Mailing Address - Phone:515-274-9676
Mailing Address - Fax:515-274-9681
Practice Address - Street 1:1101 73RD ST
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1313
Practice Address - Country:US
Practice Address - Phone:515-274-9676
Practice Address - Fax:515-274-9681
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist