Individual
MICHAEL MCNULTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
27624 121ST ST NW, ZIMMERMAN, MN 55398-9574
(612) 709-4775
Mailing address
27624 121ST ST NW, ZIMMERMAN, MN 55398-9574
(612) 709-4775
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
116328
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116328
PHARMACIST LICENSE
MN
Enumeration date
01/20/2022
Last updated
01/20/2022
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