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NPI Code Detail

MEDICARE: TYSON MULLEN PHARMD

MEDICARE: TYSON MULLEN PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist1-14790KS

General Provider Information

NPI Number : 1205227410
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYSON MULLEN PHARMD
Provider Business Mailing Address
First Line : 219 N MAIN ST
Second Line : PO BOX 570
City : ULYSSES
State : KS
Zip : 67880-2130
Country : US
Telephone Number : 620-356-1446
Fax Number :
Provider Business Practice Location Address
First Line : 219 N MAIN ST
Second Line :
City : ULYSSES
State : KS
Zip : 67880-2130
Country : US
Telephone Number : 620-356-1446
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2015
Last Update Date : 02/10/2015

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Directions to “ TYSON MULLEN PHARMD” Practice Location

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