Healthcare Provider Details

I. General information

NPI: 1093910002
Provider Name (Legal Business Name): STEVEN JAMES MULRYAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WYOMING BLVD NE
ALBUQUERQUE NM
87112-2866
US

IV. Provider business mailing address

3720 GENERAL STILWELL ST NE
ALBUQUERQUE NM
87111-3260
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-1241
  • Fax: 505-217-1241
Mailing address:
  • Phone: 505-299-1782
  • Fax: 505-217-1241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4361
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: