Provider Demographics
NPI:1295810802
Name:MULVANEY, NANCY J (RPH)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:MULVANEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CONESUS
Mailing Address - State:NY
Mailing Address - Zip Code:14435-9771
Mailing Address - Country:US
Mailing Address - Phone:585-346-0648
Mailing Address - Fax:
Practice Address - Street 1:5975 BIG TREE RD.
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480
Practice Address - Country:US
Practice Address - Phone:585-346-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist