Provider Demographics
NPI:1992745798
Name:MULLIN, SHANTEL MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHANTEL
Middle Name:MARIE
Last Name:MULLIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 KING ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1301
Mailing Address - Country:US
Mailing Address - Phone:801-581-2147
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PHARMACY SERVICES
Practice Address - Street 2:50 NORTH MEDICAL DRIVE, A-050
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-2147
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT95-295849-1701183500000X
IDP5141183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist