Individual
BONITA GOYCE MULLIENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMACISST
Contact information
Practice address
8207 N FLORIDA AVE, TAMPA, FL 33604-3003
(813) 549-5599
Mailing address
317 PINE BLUFF DR, LUTZ, FL 33549-5001
(813) 454-7254
(813) 200-6175
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS21407
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS21407
BOARD OF PHARMACY
FL
Enumeration date
04/23/2019
Last updated
04/23/2019
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