=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164656302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY SILKA R.PH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2009
-----------------------------------------------------
Last Update Date | 03/30/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7358 SECOR RD
-----------------------------------------------------
City | LAMBERTVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48144-9737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-856-7984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3057 DEAN RD
-----------------------------------------------------
City | LAMBERTVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48144-9695
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-708-0916
-----------------------------------------------------
Fax | 419-893-5158
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03-2-26267
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 5302046337
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------