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General NPI Number Information
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NPI Number | 1003102914
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Entity Type | Individual
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Provider Name | MALENA BULLARD PHARM D
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Gender | Female
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 08/25/2018
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Provider Practice Location Address
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Address Line | 1205 S WOODLAND BLVD STE 5
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City | DELAND
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State | FL
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Zip | 32720
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Country | US
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Telephone | 386-888-4912
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Fax | 386-269-9950
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Provider Business Mailing Address
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Address Line | 2650 DAKOTA DR
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City | DELAND
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State | FL
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Zip | 32724-9636
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Country | US
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Telephone | 310-634-5362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS32524
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH50132
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License Number State | CA
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