Healthcare Provider Details

I. General information

NPI: 1982980207
Provider Name (Legal Business Name): MOLLY M MILLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 E WASHINGTON AVE
MADISON WI
53704-5142
US

IV. Provider business mailing address

1504 BLUE RIDGE TRL
WAUNAKEE WI
53597-2319
US

V. Phone/Fax

Practice location:
  • Phone: 608-244-1301
  • Fax:
Mailing address:
  • Phone: 608-850-9370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13274-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: