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General NPI Number Information
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NPI Number | 1457987893
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Entity Type | Individual
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Provider Name | MEGAN MULLALLEY PHARMD
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 4393 S RIVERBOAT RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-2503
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Country | US
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Telephone | 513-404-9599
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Fax |
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Provider Business Mailing Address
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Address Line | 4393 S RIVERBOAT RD
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-2503
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Country | US
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Telephone | 513-404-9599
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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 | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | 03230073
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | 11345639-1701
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License Number State | UT
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