MEDICARE: DIANA BORREL MOLDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS15470	FL

General Provider Information

NPI Number	:	1023387537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA BORREL MOLDON

Provider Business Mailing Address
First Line	:	4384 SW 12TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2713
Country	:	US
Telephone Number	:	305-448-6121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4384 SW 12TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-2713
Country	:	US
Telephone Number	:	305-448-6121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2011
Last Update Date	:	12/29/2011

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Directions to “ DIANA BORREL MOLDON ” Practice Location

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