Provider Demographics
NPI:1669889770
Name:MULLINS, ROBERT C (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:MULLINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-2800
Mailing Address - Country:US
Mailing Address - Phone:360-723-9007
Mailing Address - Fax:360-687-8192
Practice Address - Street 1:1201 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-2800
Practice Address - Country:US
Practice Address - Phone:360-723-9007
Practice Address - Fax:360-687-8192
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00020011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist