Provider Demographics
NPI:1912064320
Name:MULKERRINS, COLMAN M JR (PHARM D)
Entity Type:Individual
Prefix:
First Name:COLMAN
Middle Name:M
Last Name:MULKERRINS
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 N GARFIELD ST
Mailing Address - Street 2:APT 532
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2548
Mailing Address - Country:US
Mailing Address - Phone:703-527-3648
Mailing Address - Fax:
Practice Address - Street 1:11445 SUNSET HILLS RD
Practice Address - Street 2:SUITE 300 PBS
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist