Provider Demographics
NPI:1750826640
Name:MULLINS, TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:MULLINS
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:CLINCHCO
Mailing Address - State:VA
Mailing Address - Zip Code:24226-0212
Mailing Address - Country:US
Mailing Address - Phone:276-275-9079
Mailing Address - Fax:606-432-4587
Practice Address - Street 1:2138 S MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2296
Practice Address - Country:US
Practice Address - Phone:606-432-2044
Practice Address - Fax:606-432-4587
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018095183500000X
VA0202214010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist