Provider Demographics
NPI:1851790273
Name:MULLINS, SHANDI (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHANDI
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PHARM D
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 1251
Mailing Address - Street 2:
Mailing Address - City:MOUNT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25637-1251
Mailing Address - Country:US
Mailing Address - Phone:304-239-6265
Mailing Address - Fax:
Practice Address - Street 1:164 HOLDEN RD
Practice Address - Street 2:
Practice Address - City:MT GAY
Practice Address - State:WV
Practice Address - Zip Code:25637
Practice Address - Country:US
Practice Address - Phone:304-239-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202213387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist