Provider Demographics
NPI:1427658053
Name:MULLERY, MINDY LORENA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LORENA
Last Name:MULLERY
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15414 BAY GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5812
Mailing Address - Country:US
Mailing Address - Phone:281-467-1638
Mailing Address - Fax:
Practice Address - Street 1:9025 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-3870
Practice Address - Country:US
Practice Address - Phone:281-479-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32392183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist