Healthcare Provider Details

I. General information

NPI: 1336085075
Provider Name (Legal Business Name): THOMAS MCNULTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 CHAPARRAL CT
ALTADENA CA
91001-3859
US

IV. Provider business mailing address

559 CHAPARRAL CT
ALTADENA CA
91001-3859
US

V. Phone/Fax

Practice location:
  • Phone: 818-209-5011
  • Fax:
Mailing address:
  • Phone: 818-209-5011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: