MEDICARE: DR. PAMELA K MULLEN PHARM D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	26023302A	IN

General Provider Information

NPI Number	:	1114213378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA K MULLEN PHARM D

Provider Business Mailing Address
First Line	:	1300 E 86TH ST
Second Line	:	STE. 35: T-1848
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1997
Country	:	US
Telephone Number	:	317-810-0045
Fax Number	:	317-810-0045

Provider Business Practice Location Address
First Line	:	1300 E 86TH ST
Second Line	:	STE. 35: T-1848
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1997
Country	:	US
Telephone Number	:	317-810-0045
Fax Number	:	317-810-0045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2011
Last Update Date	:	06/24/2011

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