Healthcare Provider Details

I. General information

NPI: 1710377361
Provider Name (Legal Business Name): ANDREW MOLUF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 RENAISSANCE PKWY
DURHAM NC
27713-6688
US

IV. Provider business mailing address

8210 RENAISSANCE PKWY
DURHAM NC
27713-6688
US

V. Phone/Fax

Practice location:
  • Phone: 919-425-0002
  • Fax: 919-237-7169
Mailing address:
  • Phone: 919-425-0002
  • Fax: 919-237-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number25260
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: