Provider Demographics
NPI:1659971091
Name:JARRELL, LAUREN MULLINS (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MULLINS
Last Name:JARRELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8042
Mailing Address - Country:US
Mailing Address - Phone:606-793-1781
Mailing Address - Fax:
Practice Address - Street 1:477 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1146
Practice Address - Country:US
Practice Address - Phone:606-886-1100
Practice Address - Fax:606-886-2088
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY019170183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist