Healthcare Provider Details

I. General information

NPI: 1043814908
Provider Name (Legal Business Name): JENNIFER MOLENDA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2020
Last Update Date: 11/22/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36008 DETROIT RD
AVON OH
44011-1641
US

IV. Provider business mailing address

36008 DETROIT RD
AVON OH
44011-1641
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-4027
  • Fax: 440-937-4038
Mailing address:
  • Phone: 440-937-4027
  • Fax: 440-937-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03226415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: