Provider Demographics
NPI:1063595726
Name:MULLAY ENTERPRISES, INC.
Entity type:Organization
Organization Name:MULLAY ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MULLAY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-567-3072
Mailing Address - Street 1:114 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1838
Mailing Address - Country:US
Mailing Address - Phone:541-567-3072
Mailing Address - Fax:
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1838
Practice Address - Country:US
Practice Address - Phone:541-567-3072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR002343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3802065OtherNABP NUMBER
OR087304Medicaid