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General NPI Number Information
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NPI Number | 1861218471
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Entity Type | Individual
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Provider Name | MOLLY MARIE GRASBERGER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 2200 RANDALLIA DR
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City | FORT WAYNE
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State | IN
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Zip | 46805-4638
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Country | US
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Telephone | 260-373-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 ARDMORE AVE APT 118
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City | FORT WAYNE
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State | IN
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Zip | 46802-4861
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Country | US
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Telephone | 260-348-4127
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 1835P1200X
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 1835P1200X
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1835I0206X
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Taxonomy Name | Infectious Diseases Pharmacist
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License Number | 26026993A
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License Number State | IN
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