Provider Demographics
NPI:1922392737
Name:MULLINS, PATRICK BURTON (RPH)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BURTON
Last Name:MULLINS
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 1:2190 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7102
Mailing Address - Country:US
Mailing Address - Phone:336-379-1053
Mailing Address - Fax:336-379-7885
Practice Address - Street 1:2190 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7102
Practice Address - Country:US
Practice Address - Phone:336-379-1053
Practice Address - Fax:336-379-7885
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12041183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12041OtherNORTH CAROLINA BOARD OF PHARMACY