Healthcare Provider Details

I. General information

NPI: 1972467173
Provider Name (Legal Business Name): NIKKI MULLIGAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5148
  • Fax: 951-486-4160
Mailing address:
  • Phone: 951-486-5148
  • Fax: 951-486-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License NumberRPH0016101
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1835I0206X
TaxonomyInfectious Diseases Pharmacist
License NumberRPH7616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: