Healthcare Provider Details

I. General information

NPI: 1295810802
Provider Name (Legal Business Name): NANCY J MULVANEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5975 BIG TREE RD.
LAKEVILLE NY
14480
US

IV. Provider business mailing address

5456 CLARK RD
CONESUS NY
14435-9771
US

V. Phone/Fax

Practice location:
  • Phone: 585-346-5615
  • Fax:
Mailing address:
  • Phone: 585-346-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number36138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: