Provider Demographics
NPI:1659705473
Name:BULLEN, ERIC BRIAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:BRIAN
Last Name:BULLEN
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 1:1255 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2653
Mailing Address - Country:US
Mailing Address - Phone:307-332-0240
Mailing Address - Fax:307-332-5041
Practice Address - Street 1:1255 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2653
Practice Address - Country:US
Practice Address - Phone:307-332-0240
Practice Address - Fax:307-332-5041
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist