Provider Demographics
NPI:1992788327
Name:MCNULTY, MICHAEL FRANCIS (BS,RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:BS,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2926
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-0926
Mailing Address - Country:US
Mailing Address - Phone:330-966-1841
Mailing Address - Fax:330-833-2211
Practice Address - Street 1:3000 ERIE ST S
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-7976
Practice Address - Country:US
Practice Address - Phone:330-833-3135
Practice Address - Fax:330-833-2211
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-088031835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric