MEDICARE: MITCHELL MCNULTY 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
1	183500000X	Pharmacist	19854	IA

General Provider Information

NPI Number	:	1326692690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL MCNULTY PHARMD

Provider Business Mailing Address
First Line	:	1101 73RD ST
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1313
Country	:	US
Telephone Number	:	515-274-9676
Fax Number	:	515-274-9681

Provider Business Practice Location Address
First Line	:	1101 73RD ST
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1313
Country	:	US
Telephone Number	:	515-274-9676
Fax Number	:	515-274-9681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2019
Last Update Date	:	07/25/2019

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