Provider Demographics
NPI:1356776652
Name:MULUGETA, NATHNEAL G (PHARMD)
Entity type:Individual
Prefix:
First Name:NATHNEAL
Middle Name:G
Last Name:MULUGETA
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 1:317 NW 42ND ST
Mailing Address - Street 2:OAKLAND PARK, FL 33309
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4709
Mailing Address - Country:US
Mailing Address - Phone:814-384-7500
Mailing Address - Fax:
Practice Address - Street 1:15601 SAN CARLOS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-2570
Practice Address - Country:US
Practice Address - Phone:239-489-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist