Healthcare Provider Details

I. General information

NPI: 1033243654
Provider Name (Legal Business Name): CARMITA LASHON MCMULLEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LARGOVISTA DR
OAKLAND FL
34787-8981
US

IV. Provider business mailing address

201 LARGOVISTA DR
OAKLAND FL
34787-8981
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-5967
  • Fax:
Mailing address:
  • Phone: 407-877-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS29479
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: