=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972901700
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBEKAH MULLAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2014
-----------------------------------------------------
Last Update Date | 12/10/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9635 WILLIAM PENN HWY
-----------------------------------------------------
City | HUNTINGDON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16652-7161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-643-3661
-----------------------------------------------------
Fax | 814-643-4516
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 MAPLE LN
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16686-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-932-2973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP447518
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPI007762
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------