Provider Demographics
NPI:1639336712
Name:MULLIGAN, NICOLE JEAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JEAN
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N LIBERTY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8523
Mailing Address - Country:US
Mailing Address - Phone:509-891-6967
Mailing Address - Fax:
Practice Address - Street 1:1304 N LIBERTY LAKE RD
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-8523
Practice Address - Country:US
Practice Address - Phone:509-891-6967
Practice Address - Fax:509-891-0584
Is Sole Proprietor?:No
Enumeration Date:2008-05-17
Last Update Date:2008-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00019354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist