Provider Demographics
NPI:1871089458
Name:MULLEN, JEFFREY J (RPH)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:MULLEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4927 MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-2030
Mailing Address - Country:US
Mailing Address - Phone:515-264-1503
Mailing Address - Fax:
Practice Address - Street 1:4927 MAPLE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-2030
Practice Address - Country:US
Practice Address - Phone:515-264-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8629183500000X
CO14697183500000X
IA17217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist