=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447774724
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY ELIZABETH BURNETT PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2017
-----------------------------------------------------
Last Update Date | 07/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 S BROAD ST LBBY 2
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19107-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-330-0290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 DELAWARE AVE
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19074-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-316-9675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP451613
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------