Provider Demographics
NPI:1649593351
Name:MULLINS, JANE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:MULLINS
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 1:1018 N JESSE JAMES RD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1202
Mailing Address - Country:US
Mailing Address - Phone:816-637-5555
Mailing Address - Fax:816-637-5701
Practice Address - Street 1:1018 N JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1202
Practice Address - Country:US
Practice Address - Phone:816-637-5555
Practice Address - Fax:816-637-5701
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044641183500000X
KS1-12530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600199202Medicaid