Provider Demographics
NPI:1790073070
Name:MULLEN, MICHAEL JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MULLEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9145
Mailing Address - Country:US
Mailing Address - Phone:336-841-6461
Mailing Address - Fax:336-841-6461
Practice Address - Street 1:2200 WESTCHESTER DR
Practice Address - Street 2:ST 126
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7099
Practice Address - Country:US
Practice Address - Phone:336-881-1060
Practice Address - Fax:336-889-9293
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC07372183500000X
VA0202006146183500000X
SC5538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist