Healthcare Provider Details

I. General information

NPI: 1376833996
Provider Name (Legal Business Name): FRED J MOLL BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 N 5TH ST
READING PA
19605-2450
US

IV. Provider business mailing address

3215 N 5TH ST
READING PA
19605-2450
US

V. Phone/Fax

Practice location:
  • Phone: 610-929-9775
  • Fax: 610-939-9930
Mailing address:
  • Phone: 610-929-9775
  • Fax: 610-939-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP026162L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: