Provider Demographics
NPI:1336718964
Name:MCMULLEN, MIRANDA LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:LYNN
Last Name:MCMULLEN
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 1:1460 MONTREAL ST SE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3318
Mailing Address - Country:US
Mailing Address - Phone:320-597-2509
Mailing Address - Fax:
Practice Address - Street 1:1460 MONTREAL ST SE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3318
Practice Address - Country:US
Practice Address - Phone:320-597-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist