Provider Demographics
NPI:1013058098
Name:MULLINS, QUENTON A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:QUENTON
Middle Name:A
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 1:8939 BRISTOL PINE LN APT 206
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4177
Mailing Address - Country:US
Mailing Address - Phone:601-551-1678
Mailing Address - Fax:
Practice Address - Street 1:1640 CENTURY CENTER PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-8822
Practice Address - Country:US
Practice Address - Phone:901-381-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010138183500000X
TN32426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist