Healthcare Provider Details

I. General information

NPI: 1326320664
Provider Name (Legal Business Name): MARK BERNARD MULVANEY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 NE PACIFIC ST BOX 356015
SEATTLE WA
98195-6015
US

IV. Provider business mailing address

1959 NE PACIFIC ST BOX 356015
SEATTLE WA
98195-6015
US

V. Phone/Fax

Practice location:
  • Phone: 206-598-6060
  • Fax:
Mailing address:
  • Phone: 206-598-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60018791
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60018791
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: