Provider Demographics
NPI:1770283871
Name:LUBULA, MULU YACOUBA (PHARMD, MBA, MS)
Entity type:Individual
Prefix:
First Name:MULU
Middle Name:YACOUBA
Last Name:LUBULA
Suffix:
Gender:M
Credentials:PHARMD, MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 RENKIN DR
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3864
Mailing Address - Country:US
Mailing Address - Phone:802-343-1799
Mailing Address - Fax:
Practice Address - Street 1:4993 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255-9768
Practice Address - Country:US
Practice Address - Phone:802-362-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033.01346111835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist