Individual provider Active NPI

Steven James Mulryan, RPH

  • Pharmacist
  • Albuquerque, NM
National Provider Identifier
1093910002
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
4361 Issued in NM
Practice address
1900 Wyoming Blvd NE
Albuquerque, NM 87112-2866
Phone
(505) 217-1241
Fax
(505) 217-1241
NPI assigned
Jun 19, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 4361 NM Primary

Addresses

Primary practice location

1900 Wyoming Blvd NE
Albuquerque, NM 87112-2866

Mailing address

3720 General Stilwell St NE
Albuquerque, NM 87111-3260
Phone (505) 299-1782

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
4361NMMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Walgreen Co Past Accepting new patients
Walgreen Co Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093910002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3720 GENERAL STILWELL ST NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871113260",
            "telephone_number": "505-299-1782",
            "fax_number": "505-217-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WYOMING BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871122866",
            "telephone_number": "505-217-1241",
            "fax_number": "505-217-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULRYAN",
        "first_name": "STEVEN",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NM",
            "license": "4361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.