Provider Demographics
NPI:1467751891
Name:MULLICAN, LOWANDA B
Entity Type:Individual
Prefix:
First Name:LOWANDA
Middle Name:B
Last Name:MULLICAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 MEADOW GREEN RD
Mailing Address - Street 2:
Mailing Address - City:MIMS
Mailing Address - State:FL
Mailing Address - Zip Code:32754-4600
Mailing Address - Country:US
Mailing Address - Phone:321-747-6833
Mailing Address - Fax:
Practice Address - Street 1:4490 MEADOW GREEN RD
Practice Address - Street 2:
Practice Address - City:MIMS
Practice Address - State:FL
Practice Address - Zip Code:32754-4600
Practice Address - Country:US
Practice Address - Phone:321-747-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10315183500000X
FLPS32853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist