Provider Demographics
NPI:1700079902
Name:MULLET, DEBRA LYN (RPH)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYN
Last Name:MULLET
Suffix:
Gender:F
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44610-0068
Mailing Address - Country:US
Mailing Address - Phone:330-231-0919
Mailing Address - Fax:
Practice Address - Street 1:4912 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:OH
Practice Address - Zip Code:44610
Practice Address - Country:US
Practice Address - Phone:330-893-3179
Practice Address - Fax:330-893-3019
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2020-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28123183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist