Provider Demographics
NPI:1255763421
Name:MULLEN, KRISTEN DANIELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7644 VOICE OF AMERICA CENTRE DR
Mailing Address - Street 2:T1534
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2794
Mailing Address - Country:US
Mailing Address - Phone:513-712-1002
Mailing Address - Fax:
Practice Address - Street 1:7644 VOICE OF AMERICA CENTRE DR
Practice Address - Street 2:T1534
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2794
Practice Address - Country:US
Practice Address - Phone:513-712-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232939183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist