Provider Demographics
NPI:1831322346
Name:MULLEN, STACEY (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:ERSKINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:325 RARITAN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2700
Mailing Address - Country:US
Mailing Address - Phone:732-545-0687
Mailing Address - Fax:732-545-1156
Practice Address - Street 1:325 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2700
Practice Address - Country:US
Practice Address - Phone:732-545-0687
Practice Address - Fax:732-545-1156
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03291300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist