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General NPI Number Information
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NPI Number | 1154721603
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Entity Type | Individual
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Provider Name | MOLLY EILEEN BROUSSARD
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Gender | Female
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 299 N BINKLEY ST
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City | SOLDOTNA
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State | AK
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Zip | 99669-7523
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Country | US
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Telephone | 907-262-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 108 LINWOOD LN
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City | KENAI
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State | AK
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Zip | 99611-8111
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Country | US
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Telephone | 907-714-1621
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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 | 113742
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 71279
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License Number State | CA
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