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General NPI Number Information
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NPI Number | 1124047832
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Entity Type | Individual
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Provider Name | LARRY ALAN MOLE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3801 MIRANDA AVE #132
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City | PALO ALTO
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State | CA
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Zip | 94304-1207
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Country | US
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Telephone | 650-849-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 2741 DIAMOND ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94131-3003
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Country | US
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Telephone | 415-452-9811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 41842
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License Number State | CA
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