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General NPI Number Information
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NPI Number | 1285641415
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Entity Type | Individual
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Provider Name | DAVID LANIER MULL R PH
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1700 MONROE DR NE KROGER PHARMACY
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City | ATLANTA
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State | GA
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Zip | 30324-5033
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Country | US
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Telephone | 404-872-0785
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Fax | 404-873-7063
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Provider Business Mailing Address
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Address Line | 1780 MERTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30306-3006
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Country | US
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Telephone | 404-347-8121
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Fax | 404-347-8121
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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 | 012908
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License Number State | GA
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