Healthcare Provider Details

I. General information

NPI: 1174451371
Provider Name (Legal Business Name): ANDREW PEARCE MULL PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W STATE ST
BOISE ID
83702-4040
US

IV. Provider business mailing address

521 E 41ST ST
GARDEN CITY ID
83714-6535
US

V. Phone/Fax

Practice location:
  • Phone: 208-342-5651
  • Fax:
Mailing address:
  • Phone: 928-925-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8671275
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: