Provider Demographics
NPI:1114213378
Name:MULLEN, PAMELA K (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:K
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E 86TH ST
Mailing Address - Street 2:STE. 35: T-1848
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1997
Mailing Address - Country:US
Mailing Address - Phone:317-810-0045
Mailing Address - Fax:317-810-0045
Practice Address - Street 1:1300 E 86TH ST
Practice Address - Street 2:STE. 35: T-1848
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1997
Practice Address - Country:US
Practice Address - Phone:317-810-0045
Practice Address - Fax:317-810-0045
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023302A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist