Healthcare Provider Details

I. General information

NPI: 1457288276
Provider Name (Legal Business Name): LAURA MOLIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9843 WINDISCH RD
WEST CHESTER OH
45069-3826
US

IV. Provider business mailing address

11094 STAFFORD HTS
INDEPENDENCE KY
41051-9700
US

V. Phone/Fax

Practice location:
  • Phone: 800-486-2668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number012054
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: