Healthcare Provider Details

I. General information

NPI: 1144506841
Provider Name (Legal Business Name): IRVIN GUSTAVO MOLINA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

5520 LINCOLN ST
HOLLYWOOD FL
33021-5732
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 954-303-3978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS48079
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: