Healthcare Provider Details

I. General information

NPI: 1316631096
Provider Name (Legal Business Name): JESSICA MOLNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 1ST STREET A
MOLINE IL
61265-7728
US

IV. Provider business mailing address

4706 LAUREN LN
BETTENDORF IA
52722-1277
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-9320
  • Fax: 309-797-0199
Mailing address:
  • Phone: 815-277-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051305513
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: