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General NPI Number Information
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NPI Number | 1821165515
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Entity Type | Individual
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Provider Name | VICTOR GRADY MULLINS III RPH
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Gender | Male
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 126 WILDWOOD PKWY
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City | BIRMINGHAM
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State | AL
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Zip | 35209-7153
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Country | US
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Telephone | 205-940-9037
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Fax | 205-941-0242
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Provider Business Mailing Address
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Address Line | 550 BRISTOL LN
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City | BIRMINGHAM
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State | AL
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Zip | 35226-1947
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Country | US
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Telephone | 205-916-0336
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Fax | 205-941-0242
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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 | 9727
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License Number State | AL
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