Individual
AMY LUCKENBILL MULLANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
102 W VANDALIA ST, EDWARDSVILLE, IL 62025-1910
(618) 692-7251
Mailing address
102 W VANDALIA ST, EDWARDSVILLE, IL 62025-1910
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051-037208
IL
Other
Enumeration date
09/20/2011
Last updated
09/28/2011
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