Provider Demographics
NPI:1316915275
Name:MULLINS, DEANN MARIE (RPH, CDE)
Entity type:Individual
Prefix:
First Name:DEANN
Middle Name:MARIE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5112
Mailing Address - Country:US
Mailing Address - Phone:850-271-4731
Mailing Address - Fax:
Practice Address - Street 1:726A OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-1758
Practice Address - Country:US
Practice Address - Phone:850-265-5744
Practice Address - Fax:850-265-5745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist