Healthcare Provider Details

I. General information

NPI: 1861668436
Provider Name (Legal Business Name): MOLLY PATRICIA ALLEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY PATRICIA KRAUS PHARMD

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 N ROSS ST
BEAVERTON MI
48612-8165
US

IV. Provider business mailing address

352 N ROSS ST PO BOX 458
BEAVERTON MI
48612-8165
US

V. Phone/Fax

Practice location:
  • Phone: 989-435-7727
  • Fax:
Mailing address:
  • Phone: 989-435-7727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302033629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: