Provider Demographics
NPI:1568744266
Name:MULLADY, MAURA ELIZABETH (PHARM D)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ELIZABETH
Last Name:MULLADY
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 1:3715 RUNNYMEDE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4513
Mailing Address - Country:US
Mailing Address - Phone:314-602-3706
Mailing Address - Fax:
Practice Address - Street 1:2248 WELSCH INDUSTRIAL CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4222
Practice Address - Country:US
Practice Address - Phone:314-356-9830
Practice Address - Fax:314-356-9850
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010022986183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist