Provider Demographics
NPI:1245512938
Name:MULLEN, LEVONNE TARAFA (PHARM D)
Entity type:Individual
Prefix:
First Name:LEVONNE
Middle Name:TARAFA
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:LEVONNE
Other - Middle Name:
Other - Last Name:TARAFA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:2501 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4534
Mailing Address - Country:US
Mailing Address - Phone:305-848-6464
Mailing Address - Fax:
Practice Address - Street 1:2501 BROADWAY
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4534
Practice Address - Country:US
Practice Address - Phone:305-848-6464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist