Healthcare Provider Details

I. General information

NPI: 1114143500
Provider Name (Legal Business Name): STEPHEN ALAN MULLENIX R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 MOUNT OLIVE RD
MOUNT OLIVE AL
35117-3925
US

IV. Provider business mailing address

PO BOX 847
GARDENDALE AL
35071-0847
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-1201
  • Fax: 205-608-1596
Mailing address:
  • Phone: 205-631-1201
  • Fax: 205-608-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10926
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: