Healthcare Provider Details

I. General information

NPI: 1104732619
Provider Name (Legal Business Name): MOLLY ELIZABETH MAHAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

601 SAND PEARL LN APT 141
MADISON WI
53711-9143
US

V. Phone/Fax

Practice location:
  • Phone: 812-890-8868
  • Fax:
Mailing address:
  • Phone: 812-890-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number23612-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: