Provider Demographics
NPI:1679897714
Name:MULLANEY, MARTIN JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JAMES
Last Name:MULLANEY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6096 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1618
Mailing Address - Country:US
Mailing Address - Phone:513-731-1400
Mailing Address - Fax:513-458-6133
Practice Address - Street 1:6096 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-1618
Practice Address - Country:US
Practice Address - Phone:513-731-1400
Practice Address - Fax:513-458-6133
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03107777183500000X
SC6862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03107777OtherOHIO PHARMACIST